Personality, physical activity, and symptoms of anxiety and depression: the HUNT study

Barriers to upper gastrointestinal screening among the general population in high-prevalence areas: a cross-sectional study

BACKGROUND

In China, there are large differences between regions in the use of gastroscopies and public awareness of upper gastrointestinal (UGI) screening.

OBJECTIVE

This study investigated the current context and analyzed the barriers that influence UGI screening behavior among the general population in UGI cancer high-prevalence areas.

METHODS

A total of 320 participants anonymously answered an online questionnaire. The rank sum test was used to analyze the difference in the scores of the UGI screening awareness questionnaire among participants with different socio-demographic characteristics. Using the awareness level of UGI screening and gastroscopy as the dependent variable, and the socio-demographic characteristics as the independent variable, simple linear regression and binary logistic regression analysis were used to determine the factors influencing attitudes toward gastroscopy screening. We used Spearman's correlation analysis to examine the correlation between UGI screening awareness level and willingness to undergo a gastroscopy.

RESULTS

There was a correlation between the willingness to undergo gastroscopy and the awareness level of UGI screening (r = 0.243, p < 0.001). Linear regression analysis found that age, type of residence, education level, employment status, monthly income, history of gastroscopy, dietary habits, physical exercise, and convenience in obtaining information were significantly correlated with the awareness level of UGI screening ( p < 0.05). Binary logistic regression analysis found that factors significantly associated with gastric cancer screening behavior include residence, monthly income, and self-perceived health status ( p  < 0.05).

CONCLUSION

It is necessary to improve education about UGI cancer and screening knowledge, with a focus on populations with lower education and income.

Relationship between Baseline Physical Activity and Generalized Anxiety Disorder and Major Depressive Disorder Treatment Outcomes

OBJECTIVES

Generalized anxiety disorder and major depressive disorder often benefit from medication and psychotherapy. Our aim was to determine whether a correlation exists between patient baseline physical activity and response to treatment.

METHODS

This was a retrospective study that included adult patients with anxiety and depression who received outpatient care for their conditions by providers in the Department of Psychiatry and Psychology of the Mayo Clinic in Jacksonville, Florida. Statistical analyses were used to analyze whether Rapid Assessment of Physical Activity scores as a measure of baseline exercise correlated to changes in Patient Health Questionnaire-9 (PHQ-9) scores or Generalized Anxiety Disorder-7-item scale (GAD-7) scores during treatment for anxiety or depression. Factors including age, sex, smoking status, and caffeine intake also were analyzed.

RESULTS

When comparing change in GAD-7 or PHQ-9 scores from baseline to follow-up during treatment for anxiety or depression, there was no significant difference based on Rapid Assessment of Physical Activity scores. Caffeine intake had a direct correlation with PHQ-9 scores from baseline to 12 to 24 weeks but no correlation with GAD-7 scores.

CONCLUSIONS

Overall, the amount of physical activity a patient participates in before anxiety or depression treatment does not appear to affect improvement outcomes. Caffeine intake may improve depression severity scores; however, further research is needed to assess whether this could be a part of future treatment plans.

Anxiety and depression in dry eye patients during the COVID-19 pandemic: Mental state investigation and influencing factor analysis

Objective

Investigate the anxiety and depression states among dry eye (DE) patients during the COVID-19 outbreak and analyze their influence factors.

Methods

The study was conducted in a tertiary eye hospital in Tianjin, China from March–April 2021. Four hundred twenty-eight DE patients were tested with the Ocular Surface Disease Index, Short Healthy Anxiety Inventory, Hospital Anxiety and Depression Scale, and Pittsburgh Sleep Quality Index. Descriptive statistics was used to assess the difference between DE with depression or anxiety among different groups. And multiple linear regression was used to explore factors that influence anxiety and depression in DE patients.

Results

The incidence rates of anxiety and depression among DE patients during COVID-19 were 27.34 and 26.87%, respectively. The proportion with comorbid anxiety and depression was 24.30%. Patients' education level (t = −3.001, P < 0.05; t = −3.631, P < 0.05), course of disease (t = 2.341, P < 0.05; t = 2.444, P < 0.05), health anxiety (t = 3.015, P < 0.05; t = 2.731, P < 0.05), and subjective sleep quality (t = 3.610, P < 0.05; t = 4.203, P < 0.05) had certain influences on anxiety and depression.

Conclusion

The results showed that subjective symptoms of DE patients were related to depression and anxiety. Higher education, shorter disease duration, lower health anxiety levels, and better subjective sleep quality were associated with the reduced depressive and anxiety symptoms in DE patients. These findings could be deemed beneficial to the treatment and prevention of DE during the COVID-19 epidemic.

Does Change in Physical Activity During the Initial Phase of the COVID-19 Pandemic Predict Psychological Symptoms in Physically Active Adults? A Six-Month Longitudinal Study

Objectives: The current study aimed to investigate if change in physical activity during the initial phase of the COVID-19 pandemic predicted severity of anxiety and depression symptoms 6 months later in physically active adults.

Methods: A total of 855 respondents (32.6% women) completed the Hospital Anxiety and Depression Scale (HADS) at two time points and reported change in physical activity habits in the first 3 months of the COVID-19 lockdown in Norway.

Results: Women had higher prevalence rates than men for both anxiety and depression symptoms in the Unchanged, Increased and Decreased physical activity (PA) subgroups. Women and men who reported Increased PA at baseline were associated with increased risk for anxiety symptoms at time 2. Increased PA was associated with higher risk for depression at time 2 for women, but not for men.

Conclusion: The results indicate that the COVID-19 pandemic is associated with deterioration in mental health also for physically active adults.

Physical Activity Is Associated With Lower Long-Term Incidence of Anxiety in a Population-Based, Large-Scale Study

Physical activity may prevent anxiety, but the importance of exercise intensity, sex-specific mechanisms, and duration of the effects remains largely unknown. We used an observational study design to follow 395,369 individuals for up to 21 years to investigate if participation in an ultralong-distance cross-country ski race (Vasaloppet, up to 90 km) was associated with a lower risk of developing anxiety. Skiers in the race and matched non-skiers from the general population were studied after participation in the race using the Swedish population and patient registries. Skiers (n = 197,685, median age 36 years, 38% women) had a significantly lower risk of developing anxiety during the follow-up compared to non-skiers (adjusted hazard ratio, HR 0.42). However, among women, higher physical performance (measured as the finishing time to complete the race, a proxy for higher exercise dose) was associated with an increased risk of anxiety compared to slower skiing women (HR 2.00). For men, the finishing time of the race did not significantly impact the risk of anxiety. Our results support the recommendations of engaging in physical activity to decrease the risk of anxiety in both men and women. The impact of physical performance level on the risk of anxiety requires further investigations among women.

The role of physical activity on mental health and quality of life during COVID-19 outbreak: A cross-sectional study

INTRODUCTION

The COVID-19 pandemic has placed restrictions on people's physical activities. The aim of this study was to evaluate the physical activity levels of individuals and assess the effects of physical activity on quality of life, depression and anxiety levels during the COVID-19 outbreak.

METHODS

This cross-sectional study were included 2301 participants aged 20-75 years. The data were collected through the Google Forms web survey platform by the virtual snowball sampling method. In the multivariate analysis, the independent predictors were analyzed using possible factors identified in previous analyses by multinomial logistic regression analysis. Hosmer-Lemeshow and Omnibus tests were used to evaluate the logistic regression model and coefficients.

RESULTS

The mean weekly energy consumption of the participants was 875±1588 MET-min, and only 6.9% were physically active enough to maintain their health. There was a weak positive relationship between physical activity levels and quality of life, while there was a weak negative relationship between physical activity levels, depression and anxiety (p<0.05). In the multinomial logistic regression model established for comparison of physically active and inactive participants, general health status and physical health status variables were statistically significant (p<0.05). However, relationships between psychological status, social relationships and environment scores, Beck Depression and Beck Anxiety Inventory scores were not statistically significant (p>0.05).

CONCLUSIONS

Results showed that physical activity programs should be included in guidelines as an integrative approach to pandemic management. During COVID-19 outbreak, community-based rehabilitation programs are needed, and these programs should be carried out in cooperation with community stakeholders.

Adults with Loeys-Dietz syndrome and vascular Ehlers-Danlos syndrome: a cross-sectional study of patient experiences with physical activity

PURPOSE

To study patient experiences with physical activity among persons with Loeys-Dietz- or vascular Ehlers-Danlos syndrome.

MATERIALS AND METHODS

A postal questionnaire survey in 2018. Seventy adults with molecularly verified Loeys-Dietz syndrome types 1-4, or vascular Ehlers-Danlos syndrome recruited through a National Resource Centre for Rare Disorders in Norway.

RESULTS

The response rate was 74%, (Loeys-Dietz n = 34, vascular Ehlers-Danlos n = 18), aged 18 to 68 years, 58% women. In total, 88.5% reported they had received advice regarding physical activity and most (77%) had modified their habits. Fifty percent had an appropriate- and 40% a low mean physical activity sum score. Another 10% had too high physical activity levels due to high intensity scores. Lower scores with the Fatigue Severity Scale (p = 0.033) and the anxiety subscale of the Hospital Anxiety and Depression Scale (p = 0.021), were associated with high physical activity levels. About a third reported unmet rehabilitation needs.

CONCLUSION

Many adults with Loeys-Dietz- or vascular Ehlers-Danlos syndrome may have a potential to reach more favorable physical activity levels by increasing the frequency and duration of activities. Future directions should include evaluation of effects of professional-led practical and safe physical activity sessions as well as customized multidisciplinary rehabilitation programs for these patient groups.

Mental health and sleep disturbances in physically active adults during the COVID-19 lockdown in Norway: does change in physical activity level matter?

STUDY OBJECTIVE

To assess mental health and sleep disturbances among physically active adults during the Norwegian lockdown caused by the coronavirus disease 2019 (COVID-19), and to investigate if change in physical activity (PA) level during the lockdown moderates the association between mental health and sleep disturbances.

METHODS

Members of a Norwegian fitness association were invited to fill out an online questionnaire including the Hospital Anxiety and Depression Scale (HADS), sleep disturbances and change in PA habits (decreased, unchanged, increased) during the COVID-19 lockdown from 12 March to 15 June 2020.

RESULTS

A sample of 1281 members aged 19-81 years were included (31% females; mean ± SD age 49 ± 11.5). Prevalence of anxiety and depressive symptoms was 9.0% and 4.4%, respectively. During the lockdown period, 13.8% reduced, 21.9% increased and 64.3% did not change PA level. In total 21.9% reported sleeping disturbances. Anxiety symptoms and depressive symptoms were statistically significantly associated with sleep disturbances. Change in PA did not influence the association between mental health and sleep.

CONCLUSION

Compared to studies from the general population during the COVID-19 pandemic levels of anxiety and depressive symptoms were substantial lower in this Norwegian sample of relatively physically active adults. Anxiety and depressive symptoms were associated with sleep disturbances, but change in PA level during the COVID-19 lockdown did not influence the association between mental health and sleep disturbances.

The influence of restless legs symptoms on musculoskeletal pain in depression

Background and aims Restless legs syndrome is a sensorimotor disorder associated with mental health conditions notably depression. Restless legs symptoms and depression are commonly associated with pain. The study investigated the influence of restless legs symptoms on musculoskeletal pain in patients with depression or with increased depressive symptoms. Methods A cross-sectional study of primary care patients in the Central Finland Hospital District. The prevalence of restless legs symptoms was studied in patients with depressive symptoms (n = 695) and controls without a psychiatric diagnosis (n = 410) by using a structured questionnaire. The depressive symptoms were evaluated with the Beck Depression Inventory and the psychiatric diagnosis was confirmed by means of a diagnostic interview (MINI). The prevalence and intensity of musculoskeletal pain was captured with form-based questions. A single-question screen for restless legs symptoms was applied. Results There was a significant difference in the prevalence of continuous widespread musculoskeletal pain between the three study groups: the controls 4.6% (95% CI: 2.8-7.1), the patients with symptoms of depression without a diagnosis 16.0% (11.7-21.1), and the patients with diagnosed depression 22.1% (18.3-23.3) (p = 0.006 after being adjusted for age, sex, smoking, use of alcohol, education years, body mass index, use of antidepressants, and physical activity, after multiple corrections, all groups were significantly different from each other). Compared with those not having restless legs symptoms, subjects with restless legs symptoms had more often continuous widespread musculoskeletal pain in the control subjects (p = 0.001; 2.3% vs. 10.5%) and in the patients with depressive symptoms without a depression diagnosis (p = 0.024; 9.1 vs. 18.7%) but not in those with diagnosed depression (p = 0.98; 19.5 vs. 19.4%). The restless legs symptoms were associated with the intensity of pain in all groups (p < 0.001). Conclusions Restless legs symptoms were related to continuous widespread musculoskeletal pain in subjects without depressive symptoms and in patients with depressive symptoms without a depression diagnosis. Pain intensity was higher in the subjects with restless legs symptoms regardless of depressive symtoms or depression. Implications Clinical management of pain in patients with restless legs symptoms should include an increased focus on the prevention and treatment of either conditions.

Understanding the influence of high novelty-seeking on academic burnout: Moderating effect of physical activity

A large number of studies have shown a positive correlation between high novelty-seeking (HNS), substance/medication use (S/MU), high physical activity (HPA), and academic burnout (AB); however, the outcome of individuals with HNS in the terms of catching AB is doubtful. The present study was conducted to find out whether the personality traits such as HNS in medical students predisposes the AB or decreases its severity by increased physical activity (PA). This cross-sectional study, 227 medical students with HNS were selected from three major cities of Iran during February, 2019 to July, 2019 using convenience sampling and were assessed using demographic information form, Baecke's physical activity questionnaire, and Breso's academic burnout questionnaire. In this study, 126 male and 151 female participants were divided into four groups namely HNS + low physical activity (LPA) (n = 68); HNS + HPA (n = 73); HNS + S/MU + LPA (n = 72); and HNS + S/MU + HPA (n = 64). The study results indicated that the maximum and minimum mean scores of AB and its subscales were in the HNS + S/MU + LPA and HNS + HPA groups, respectively. In addition, the hierarchical multiple regression analysis results for the two groups of students with and without S/MU indicated that PA plays a moderating role in the relationship between AB and HNS. Given that the AB can be considered as an antecedent of depressive disorders, its lowered level could be effective in preventing major depressive disorder. Regarding the moderating role of PA in the relationship between HNS and AB, PA, as a relatively simple and inexpensive alternative to pharmacotherapy and psychotherapy, can be raised in the treatment and prevention of the AB.

Daily use of alcohol in the Norwegian general population: Prevalence and associated factors

Purpose

Harmful use of alcohol is a major public health problem. While harm is often researched in the context of heavy drinking episodes, high-frequency drinking, even when drinking moderate quantities, constitutes a health risk in a longer perspective. The purpose of this paper is to examine the prevalence of daily use of alcohol in the Norwegian general population and to assess sociodemographic, mental health-related and personal resource variables associated with daily use of alcohol.

Design/methodology/approach

A cross-sectional survey concerned with health, illness and serious life events was distributed to 5,500 persons in the general population in Norway (response rate 36%). Sociodemographic variables, personal resource variables (general self-efficacy, optimism and extraversion) and psychological distress (current anxiety and/or depression) were assessed with regards to their associations with daily drinking in unadjusted and adjusted regression models.

Findings

Daily use of alcohol was reported by 39 persons (2.2%) in the sample (3.1% of men and 1.4% of women). While general self-efficacy, optimism and extraversion were unrelated to daily drinking, the adjusted model revealed that male sex (OR: 2.18, p < 0.05), being unemployed/not in education (OR: 3.10, p < 0.05) and reporting current anxiety and/or depression (OR: 3.12, p < 0.01) were associated with daily use of alcohol.

Originality/value

The study has contributed to the knowledge about daily drinkers in a representative sample of the Norwegian population. A proportion of 2.2% was found to drink alcohol on a daily basis. Compared to their counterparts, the odds of daily drinking were higher for men, unemployed persons and persons reporting current psychological distress. Public health initiatives aiming at reducing harmful use of alcohol may pay particular attention to these subsets of the population.

Physical activity and exercise in youth mental health promotion: a scoping review

BACKGROUND/AIM

This scoping review examined the breadth and outcomes of controlled trials testing the effect of physical activity and exercise interventions across all mental health outcomes for mental health promotion and indicated prevention studies in young people.

METHODS

The literature search was conducted using 'Evidence Finder'.

RESULTS

Thirty publications were included. Available evidence suggested that interventions of varying intensity may lead to a reduction in depression symptoms and that moderate-to-vigorous-intensity and light-intensity interventions may reduce anxiety symptoms. Effects of physical activity/exercise interventions on additional mental health outcomes were also shown; however, the number of studies was small, indicating a limited evidence base. Robust research regarding the effects of physical activity/exercise on mental health promotion and as an indicated prevention strategy in young people is lacking.

CONCLUSION

The available evidence suggests that physical activity/exercise is a promising mental health promotion and early intervention strategy and warrants further investigation.

Understanding the influence of high novelty-seeking on academic burnout: Moderating effect of physical activity

A large number of studies have shown a positive correlation between high novelty-seeking (HNS), substance/medication use (S/MU), high physical activity (HPA), and academic burnout (AB); however, the outcome of individuals with HNS in the terms of catching AB is doubtful. The present study was conducted to find out whether the personality traits such as HNS in medical students predisposes the AB or decreases its severity by increased physical activity (PA). This cross-sectional study, 227 medical students with HNS were selected from three major cities of Iran during February, 2019 to July, 2019 using convenience sampling and were assessed using demographic information form, Baecke’s physical activity questionnaire, and Breso’s academic burnout questionnaire. In this study, 126 male and 151 female participants were divided into four groups namely HNS + low physical activity (LPA) (n = 68); HNS + HPA (n = 73); HNS + S/MU + LPA (n = 72); and HNS + S/MU + HPA (n = 64). The study results indicated that the maximum and minimum mean scores of AB and its subscales were in the HNS + S/MU + LPA and HNS + HPA groups, respectively. In addition, the hierarchical multiple regression analysis results for the two groups of students with and without S/MU indicated that PA plays a moderating role in the relationship between AB and HNS. Given that the AB can be considered as an antecedent of depressive disorders, its lowered level could be effective in preventing major depressive disorder. Regarding the moderating role of PA in the relationship between HNS and AB, PA, as a relatively simple and inexpensive alternative to pharmacotherapy and psychotherapy, can be raised in the treatment and prevention of the AB.

Depressive symptoms are related to boredom proneness in patients receiving hospital care, regardless of alcohol status, lifestyle, or social support

We examined the relationship between boredom proneness and psychological distress in patients receiving hospital care due either to excessive alcohol consumption or to gastrointestinal diseases. Sociodemographic data were collected together with boredom proneness subscales (internal/external lack of stimulation), psychological distress, physical activity, and social support. Boredom proneness due to a lack of external stimulation seemed to constitute a prominent personality trait in patients with alcohol consumption. But depressive symptoms were related only to boredom proneness due to a lack of internal stimulation in all patients, regardless of alcohol status, lifestyle, or social support. Potential implications for practice and future research are discussed.

Frailty, Quality of Life, Anxiety, and Other Factors Affecting Adherence to Physical Activity Recommendations by Hemodialysis Patients

Hemodialysis patients perform little physical activity. We formulated a hypothesis that some factors, i.e., frailty, medical and functional factors, psychological factors, quality of life, awareness of recommendations, and sociodemographic factors influence the decisions of taking up physical activity. This prospective study comprised 72 dialysis patients aged 57.8 ± 16.0 ( x ¯ ± SD; in the range of 19-87 years of age). The following research tools were used: an interview about awareness of the physical activity recommendations, the Canadian Study of Health and Aging Scale (CSHA-CFS), scales for the assessment of functional status, State-Trait Anxiety Inventory (STAI), Acceptance of Illness Scale (AIS), and the questionnaire of Kidney Disease Quality of Life (KDQOL-SF 1.3). The majority of patients diagnosed with frailty did not follow the physical activity recommendations (79.3%). Quality of life was better in active patients compared to inactive patients, especially in the domains of sleep and physical performance. The severity of trait anxiety was significantly higher in patients who did not follow the recommendations compared to patients who adhered to physical activity recommendations (46.0 ± 10.5 vs. 40.0 ± 8.2; p = 0.021 ). The likelihood of adherence decreased by 1% after each subsequent month of dialysis (odds ratio = 0.99; 95% confidence interval = 0.972-0.999; p = 0.047 ). Adherence was most limited by frailty. Adherence to recommendations on physical activity was affected by: motivation, lower levels of trait anxiety, and better quality of life. Age modified the effect of awareness and acceptance of the disease on adherence to physical activity recommendations.

Patient-Reported Outcome Measures 2 Years After Standard and Distal Gastric Bypass-a Double-Blind Randomized Controlled Trial

BACKGROUND

The preferred surgical procedure for treating morbid obesity is debated. Patient-reported outcome measures (PROMs) are relevant for evaluation of the optimal bariatric procedure.

METHODS

A total of 113 patients with BMI from 50 to 60 were randomly assigned to standard (n = 57) or distal (n = 56) Roux-en-Y gastric bypass (RYGB). Validated PROMS questionnaires were completed at baseline and 2 years after surgery. Data were analyzed using mixed models for repeated measures and the results are expressed as estimated means and mean changes.

RESULTS

Obesity-related quality of life improved significantly after both procedures, without significant between-group differences (- 0.4 (95% CI = - 8.4, 7.2) points, p = 0.88, ES = 0.06). Both groups had significant reductions in the number of weight-related symptoms and symptom distress score, with a mean group difference (95% CI) of 1.4 (- 0.3, 3.3) symptoms and 5.0 (2.9. 12.8) symptom distress score points. There were no between-group differences for uncontrolled eating (22.0 (17.2-26.7) vs. 28.9 (23.3-34.5) points), cognitive restraint (57.4 (52.0-62.7) vs. 62.1 (57.9-66.2) points), and emotional eating (26.8 (20.5-33.1) vs. 32.6 (25.5-39.7) points). The prevalence of anxiety was 33% after standard and 25% after distal RYGB (p = 0.53), and for depression 12 and 9%, respectively (p = 0.76).

CONCLUSIONS

There were no statistically significant differences between standard and distal RYGB 2 years post surgery regarding weight loss, obesity-related quality of life, weight-related symptoms, anxiety, depression, or eating behavior.

TRIAL REGISTRATION

Clinical Trials.gov number NCT00821197.

Factors associated with daily life physical activity in patients with asthma

BACKGROUND AND OBJECTIVES

Little is known about the consequences of asthma on daily life physical activity (DLPA). The aim of this study was to evaluate DLPA and determine its relationship to clinical and functional parameters in patients with asthma.

METHODS

This was a single-center prospective study of DLPA conducted between May 2015 and June 2016 in northern France. Fifty-one adult patients with asthma and 36 healthy control subjects were enrolled. Four DLPA parameters were assessed for 5 consecutive days with a physical activity monitor: number of steps walked per day (SPD), total energy expenditure (EE, in kcal/day), EE spent in physical activity requiring ≥3 metabolic equivalents (METs), and time (min) spent in activities requiring ≥3 METs. Clinical characteristics, pulmonary function tests, 6-minute walk test, and four questionnaires (modified Medical Research Council [mMRC] for dyspnea, asthma control test [ACT], quality of life [AQLQ], and hospital anxiety and depression scale [HADS]), were evaluated. Comparisons of DLPA parameters between the two groups were performed using an analysis of covariance adjusted for age, sex, and body mass index (BMI). Relationships between DLPA parameters and patient characteristics were assessed in multivariable linear regression models.

RESULTS

Compared with patients with mild/moderate asthma, those with severe asthma had lower mean (± standard deviation) forced expiratory volume in 1 s (FEV1) (66 ± 24 vs 94 ± 15% predicted, P < 0.001), ACT score (16.7 ± 4.5 vs 19.8 ± 4.2, P = 0.015), and AQLQ score (157 ± 40 vs 184 ± 33, P = 0.012). There were no significant differences between the two groups in SPD (6560 ± 3915 vs 8546 ± 3431; adjusted P = 0.95), EE in physical activity requiring ≥3 METs (620 ± 360 vs 660 ± 140 kcal/day; P = 0.86), time spent in activities requiring EE ≥3 (120 ± 54 vs 121 ± 32 min/day; P = 0.69), or total EE (2606 ± 570 vs 2666 ± 551 kcal/day; P = 0.80). These four DLPA measures showed strong inter-parameter correlations in patients with asthma (r = 0.37-0.95, all P < 0.01). All four parameters were lower in the patients with asthma group than in the control group: SPD, 7651 ± 3755 vs 11704 ± 4054 (adjusted P < 0.001); EE in activities requiring ≥3 METs, 642 ± 360 vs 852 ± 374 kcal/day (adjusted P = 0.041); time spent in activities requiring ≥3 EE, 120 ± 73 vs 189 ± 85 min (adjusted P = 0.005); and total EE, 2639 ± 555 vs 2746 ± 449 kcal/day (adjusted P = 0.007). In the patients with asthma group, the number of SPD correlated with age, FEV1, mMRC score, 6-minute walk test distance, and HADS scores, but not with BMI or ACT test score. Using multivariate analysis, the number of SPD was associated with only age, anxiety, and FEV1, whereas total EE was associated with mMRC score and BMI.

CONCLUSION

Age, anxiety, and FEV1 were significantly associated with the number of SPD in patients with asthma. Addressing anxiety should be further studied as way to attempt to increase physical activity in patients with asthma.

Self-diagnosed depression in the Norwegian general population - associations with neuroticism, extraversion, optimism, and general self-efficacy

BACKGROUND

Multi-item rating scales for depression informs about the level of depression, but does not allow individuals to state by self-evaluation whether they feel depressed or not. The insider perspective on depression is rarely assessed. This study investigated the prevalence of self-diagnosed depression in the Norwegian general population, and associations with sociodemographic and psychological factors.

METHODS

As part of a national survey, the General Self-Efficacy Scale, the Life Orientation Test-Revised, a short version of the Eysenck Personality Questionnaire and a one-item measure of self-diagnosed depression was administered to 5.500 persons in the general Norwegian population. Of the 4961 eligible participants ≥ 18 years of age, 1.787 (response rate 36%) participated in the survey, and 1.684 of these had valid scores on the relevant scales. The associations between sociodemographic factors and self-diagnosed depression were examined using univariate and multivariate logistic regression analyses.

RESULTS

One hundred and thirty-six participants (8.1%) reported depression during the preceding month. When adjusting for sociodemographic and psychological variables, higher age (OR = 0.82), being in work (OR = 0.57), and higher levels of general self-efficacy (OR = 0.67) and optimism (OR = 0.52) were associated with lower risk of self-diagnosed depression, whereas higher levels of neuroticism (OR = 1.97) was associated with higher risk.

CONCLUSIONS

The prevalence of self-diagnosed depression in the adult Norwegian population was higher for women than for men. Higher age, being in work and having higher levels of psychological resources appear to reduce the risk of self-diagnosed depression, whereas neuroticism increases the risk.

Impact of body weight, low energy diet and gastric bypass on drug bioavailability, cardiovascular risk factors and metabolic biomarkers: protocol for an open, non-randomised, three-armed single centre study (COCKTAIL)

INTRODUCTION

Roux-en-Y gastric bypass (GBP) is associated with changes in cardiometabolic risk factors and bioavailability of drugs, but whether these changes are induced by calorie restriction, the weight loss or surgery per se, remains uncertain. The COCKTAIL study was designed to disentangle the short-term (6 weeks) metabolic and pharmacokinetic effects of GBP and a very low energy diet (VLED) by inducing a similar weight loss in the two groups.

METHODS AND ANALYSIS

This open, non-randomised, three-armed, single-centre study is performed at a tertiary care centre in Norway. It aims to compare the short-term (6 weeks) and long-term (2 years) effects of GBP and VLED on, first, bioavailability and pharmacokinetics (24 hours) of probe drugs and biomarkers and, second, their effects on metabolism, cardiometabolic risk factors and biomarkers. The primary outcomes will be measured as changes in: (1) all six probe drugs by absolute bioavailability area under the curve (AUC_oral/AUC_iv) of midazolam (CYP3A4 probe), systemic exposure (AUC_oral) of digoxin and rosuvastatin and drug:metabolite ratios for omeprazole, losartan and caffeine, levels of endogenous CYP3A biomarkers and genotypic variation, changes in the expression and activity data of the drug-metabolising, drug transport and drug regulatory proteins in biopsies from various organs and (2) body composition, cardiometabolic risk factors and metabolic biomarkers.

ETHICS AND DISSEMINATION

The COCKTAIL protocol was reviewed and approved by the Regional Committee for Medical and Health Research Ethics (Ref: 2013/2379/REK sørøst A). The results will be disseminated to academic and health professional audiences and the public via presentations at conferences, publications in peer-reviewed journals and press releases and provided to all participants.

TRIAL REGISTRATION NUMBER

NCT02386917.

Does Childhood Temperamental Activity Predict Physical Activity and Sedentary Behavior over a 30-Year Period? Evidence from the Young Finns Study

PURPOSE

We examined associations between childhood temperamental activity, physical activity (PA), and television (TV) viewing over a 30-year period.

METHOD

The participants (1220 boys and 1237 girls) were aged 3, 6, 9, and 12 years in 1980 and were followed until 2011. Temperamental activity was evaluated by participants' mothers at baseline. The PA was assessed based on maternal ratings of the child from ages 3 to 6 and via self-report age from the age of 9 across all measurements. TV viewing was assessed using self-reports taken from 2001 to 2011. The associations between temperamental activity and the level and change of PA and TV viewing were determined using linear growth modeling stratified by gender and age group.

RESULTS

High temperamental activity assessed from ages 9 to 12 was associated with high levels of childhood PA in both genders, but with a steeper decline in PA levels during the first 9 years of follow-up in boys. High temperamental activity assessed from ages 3 to 6 was associated with the decline of PA from childhood to youth in girls. High childhood temperamental activity was associated with decreased levels of PA in adulthood in men, but not in women. The associations between childhood temperamental activity and TV viewing during adulthood seemed to be positive but not consistently significant in all age and gender groups.

CONCLUSION

High temperamental activity may contribute to the development of a physically inactive lifestyle. More evidence is needed with regard to gender differences among participants in similar study settings.

The relationship between serum 25(OH)D levels and anxiety symptoms in older persons: Results from the Longitudinal Aging Study Amsterdam

OBJECTIVE

Low serum 25-hydroxyvitamin D levels (25(OH)D<50nmol/L) are common in older persons and associated with depressive symptoms. Depression and anxiety are highly interrelated, but only very few studies examined the association between 25(OH)D and anxiety. This study investigated whether 25(OH)D levels are related to anxiety symptoms in older persons, both cross-sectionally and over time.

METHODS

Data from two samples of a large population-based cohort study were used (sample 1: N=1259, 64-88years; sample 2: N=892, 60-98years). Anxiety symptoms were measured with the Hospital Anxiety and Depression Scale - Anxiety subscale at baseline and after three years; serum 25(OH)D was measured at baseline. Cross-sectional and longitudinal relationships between 25(OH)D and anxiety were examined using logistic regression analysis, taking into account relevant confounding variables.

RESULTS

Of the participants, 48.0% (sample 1) and 26.4% (sample 2) had 25(OH)D levels <50nmol/L, whereas 8.1% (sample 1) and 6.5% (sample 2) had clinically relevant anxiety symptoms. Cross-sectionally, persons with 25(OH)D<50nmol/L experienced more anxiety symptoms than persons with 25(OH)D≥50nmol/L (sample 1: OR=1.55; 95% CI: 1.03-2.32, p=0.035; sample 2: OR=1.74; 95% CI: 1.03-2.96, p=0.040). However, after adjustment for demographic and lifestyle variables and depressive symptoms, significant associations were no longer observed (p=0.25-0.72). Similarly, 25(OH)D levels were not significantly related to anxiety symptoms after three years in both samples.

CONCLUSIONS

After adjustment for confounding, there was no cross-sectional or longitudinal association between 25(OH)D levels and anxiety symptoms, independently from depression, in two large samples of older persons.

Domain-Specific Physical Activity and Mental Health: A Meta-analysis

CONTEXT

The mental health benefits of physical activity are well established. However, less is known about whether the relationship between physical activity and mental health is consistent across different life domains. It is important to understand how context may influence the relationship between physical activity and mental health so that interventions and policy guidelines can be tailored to maximize positive effects.

EVIDENCE ACQUISITION

In 2015, systematic searches of four databases identified 13,435 records, of which 98 studies met the inclusion criteria.

EVIDENCE SYNTHESIS

Included studies were published between 1988 and 2015 and had a combined sample size of 648,726. Of the 98 included studies, 93 examined leisure-time physical activity, 14 examined work-related physical activity, 15 examined transport physical activity, 16 examined household physical activity, three examined school sport, and three examined physical education. Multi-level meta-analyses showed that leisure-time physical activity (r =0.13) and transport physical activity (r =0.13) both had a positive association with mental health. Leisure-time physical activity (r = -0.11) and school sport (r = -0.09) both had an inverse association with mental ill-health. However, physical activity was not consistently associated with lower mental ill-health across domains, as work-related physical activity was positively associated with mental ill-health (r =0.09). Household physical activity and participation in physical education had no relationship with mental health or mental ill-health.

CONCLUSIONS

The domain in which physical activity occurs influences the relationship between physical activity and mental health and should, therefore, be considered when developing interventions, treatment programs, and policy guidelines.

BRCA1/2 testing in newly diagnosed breast and ovarian cancer patients without prior genetic counselling: the DNA-BONus study

Germline BRCA1/2 testing of breast and ovarian cancer patients is growing rapidly as the result affects both treatment and cancer prevention in patients and relatives. Through the DNA-BONus study we offered BRCA1/2 testing and familial risk assessment to all new patients with breast (N=893) or ovarian (N=122) cancer diagnosed between September 2012 and April 2015, irrespective of family history or age, and without prior face-to-face genetic counselling. BRCA1/2 testing was accepted by 405 (45.4%) and 83 (68.0%) of the patients with breast or ovarian cancer, respectively. A pathogenic BRCA1/2 variant was found in 7 (1.7%) of the breast cancer patients and 19 (22.3%) of the ovarian cancer patients. In retrospect, all BRCA1/2 mutation carriers appeared to fulfill current criteria for BRCA1/2 testing. Hospital Anxiety and Depression Scale (HADS) scores showed that the mean levels of anxiety and depression were comparable to those reported for breast and gynecological cancer patients in general, with a significant drop in anxiety symptoms during a 6-month follow-up period, during which the test result was forwarded to the patients. These results show that BRCA1/2 testing is well accepted in newly diagnosed breast and ovarian cancer patients. Current test criteria based on age and family history are sufficient to identify most BRCA1/2 mutation carriers among breast cancer patients. We recommend germline BRCA1/2 testing in all patients with epithelial ovarian cancer because of the high prevalence of pathogenic BRCA1/2 variants.

The effect of physical activity on mental health among adolescents with and without self-reported visual impairment: The Young-HUNT Study, Norway

The purpose was to study the effect of physical activity (PA) on mental health according to self-reported vision categories among adolescents. The study was conducted in Nord-Trøndelag, Norway, during the period 1995–1997, with a follow-up 4 years later. Self-reported measurements were used to assess PA and vision at baseline, and mental health problems and well-being at follow-up. The main linear regression analyses included 1417 adolescents between the age of 12 and 17 years, of which 46 had reported visual impairment. Among those reporting no impairment, conducting <1 day per week of PA was significantly associated with having lower levels of well-being at follow-up compared to those conducting ⩾1 day of PA. Among those reporting visual impairment, the mental health benefits of conducting weekly PA compared with conducting non-weekly PA were observed only among those who were more emotionally unstable or introvert at baseline. In conclusion, further longitudinal studies are warranted to examine whether the mental health responses of PA may be dependent on the adolescent’s vision status.

Examination of the Adlerian constructs of activity and social interest with depression among recent Korean retirees: Meaning in life as a mediator

The purpose of the present study was to investigate whether (a) the Adlerian construct of activity and social interest would be related to decreased depression and (b) meaning in life would mediate these relationships among Korean retirees. A total of 219 Korean retirees who had retired within the last three years completed the survey. The survey included the Activity Scale, Social Interest Scale, The Meaning in Life Questionnaire, and Center for Epidemiology Depression Scale. Structural equation modeling was conducted to analyze data. The results indicated that activity was directly associated with depression (β=-.453, p<.001) and indirectly related to depression through meaning in life (indirect path: β=-.279, p< .05, 95% CI=-.483, ∼-.145). Similarly, social interest was found to be directly related to depression (β=-.710, p<.001) and indirectly related to depression through meaning in life (indirect path: β=-.227, p<.05, 95% CI=-.427, ∼-.086). These findings suggest that meaning in life is an important avenue through which activity and social interest are linked to a lower level of depression among Korean retirees.

Gender-specific associations between leisure-time physical activity and symptoms of anxiety: the HUNT study

PURPOSE

The underlying goal of the study was to examine gender-specific effects of leisure-time physical activity on the development of symptoms of anxiety.

METHODS

The second wave of a prospective cohort survey (HUNT 2) was conducted during 1995-1997 in the county of Nord-Trøndelag, Norway, with a follow-up in 2006-2008 (HUNT 3). The sample consisted of 12,796 women and 11,195 men with an age range of 19-85 years. A binomial model with a log-link function and generalized linear model analysis with gamma distribution was used to assess the association between physical activity and anxiety symptoms (Hospital Anxiety and Depression Scale anxiety subscale, HADS-A).

RESULTS

A total of 1,211 (9.5 %) women and 650 (5.8 %) men developed HADS-defined anxiety (≥8 on the HADS-A scale). Men who scored in the middle tertile of the calculated physical activity index developed significantly fewer cases of HADS-defined anxiety compared with men in the lowest tertile (p < 0.05). In the gamma regression analysis for women, having higher scores on the moderate-high physical activity was associated with fewer symptoms of anxiety (p < 0.01).

CONCLUSIONS

Women developed almost twice as many cases of HADS-defined anxiety compared to men. Significant associations were found between general leisure-time physical activity and anxiety symptoms among women and men, but the true effect is likely to be different from the observed associations due to several threats to the internal validity in the study.

Don't worry, be happy: cross-sectional associations between physical activity and happiness in 15 European countries

BACKGROUND

Mental health disorders are major contributors to the global burden of disease and their inverse relationship with physical activity is widely accepted. However, research on the association between physical activity and positive mental health outcomes is limited. Happiness is an example of a positive construct of mental health that may be promoted by physical activity and could increase resilience to emotional perturbations. The aim of this study is to use a large multi-country dataset to assess the association of happiness with physical activity volume and its specificity to intensity and/or activity domain.

METHODS

We analysed Eurobarometer 2002 data from 15 countries (n = 11,637). This comprised one question assessing self-reported happiness on a six point scale (dichotomised: happy/unhappy) and physical activity data collected using the IPAQ-short (i.e. walking, moderate, vigorous) and four domain specific items (i.e. domestic, leisure, transport, vocation). Logistic regression was used to examine the association between happiness and physical activity volume adjusted for sex, age, country, general health, relationship status, employment and education. Analyses of intensity and domain specificity were assessed by logistic regression adjusted for the same covariates and physical activity volume.

RESULTS

When compared to inactive people, there was a positive dose-response association between physical activity volume and happiness (highly active: OR = 1.52 [1.28-1.80]; sufficiently active: OR = 1.29 [1.11-1.49]; insufficiently active: OR = 1.20 [1.03-1.39]). There were small positive associations with happiness for walking (OR = 1.02 [1.00-1.03]) and vigorous-intensity physical activity (OR = 1.03 [1.01-1.05). Moderate-intensity physical activity was not associated with happiness (OR = 1.01 [0.99-1.03]). The strongest domain specific associations with happiness were found for "a lot" of domestic (OR = 1.42 [1.20-1.68]) and "some" vocational (OR = 1.33 [1.08-1.64]) physical activity. Happiness was also associated with "a lot" of leisure physical activity (OR = 1.15 [1.02-1.30]), but there were no significant associations for the transport domain.

CONCLUSIONS

Increasing physical activity volume was associated with higher levels of happiness. Although the influence of physical activity intensity appeared minimal, the association with happiness was domain specific and was strongest for "a lot" of domestic and/or "some" vocational physical activity. Future studies to establish causation are indicated and may prompt changes in how physical activity for improving mental health is promoted.

Moderate-vigorous physical activity across body mass index in females: moderating effect of endocannabinoids and temperament

BACKGROUND

Endocannabinoids and temperament traits have been linked to both physical activity and body mass index (BMI) however no study has explored how these factors interact in females. The aims of this cross-sectional study were to 1) examine differences among distinct BMI groups on daytime physical activity and time spent in moderate-vigorous physical activity (MVPA), temperament traits and plasma endocannabinoid concentrations; and 2) explore the association and interaction between MVPA, temperament, endocannabinoids and BMI.

METHODS

Physical activity was measured with the wrist-worn accelerometer Actiwatch AW7, in a sample of 189 female participants (43 morbid obese, 30 obese, and 116 healthy-weight controls). The Temperament and Character Inventory-Revised questionnaire was used to assess personality traits. BMI was calculated by bioelectrical impedance analysis via the TANITA digital scale. Blood analyses were conducted to measure levels of endocannabinoids and endocannabinoid-related compounds. Path-analysis was performed to examine the association between predictive variables and MVPA.

RESULTS

Obese groups showed lower MVPA and dysfunctional temperament traits compared to healthy-weight controls. Plasma concentrations of 2-arachidonoylglyceryl (2-AG) were greater in obese groups. Path-analysis identified a direct effect between greater MVPA and low BMI (b = -0.13, p = .039) and high MVPA levels were associated with elevated anandamide (AEA) levels (b = 0.16, p = .049) and N-oleylethanolamide (OEA) levels (b = 0.22, p = .004), as well as high Novelty seeking (b = 0.18, p<.001) and low Harm avoidance (b = -0.16, p<.001).

CONCLUSIONS

Obese individuals showed a distinct temperament profile and circulating endocannabinoids compared to controls. Temperament and endocannabinoids may act as moderators of the low MVPA in obesity.

Five-year changes in health-related quality of life after biliopancreatic diversion with duodenal switch

Background

Long-term data of health-related quality of life (HRQL) after biliopancreatic diversion with duodenal switch (BPDDS) procedure are lacking. The aim of this study was to evaluate changes in HRQL from baseline to 5 years after BPDDS.

Methods

Fifty morbidly obese patients were followed for 5 years after BPDDS procedure. The sample consisted of 27 women and 23 men, the mean age was 37.8 years, and the mean body mass index (BMI) was 51.7 units. HRQL was measured with the Short Form 36 questionnaire (SF-36). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS). Linear mixed model was used to investigate the change scores. The SF-36 scores and HADS scores of the sample were also compared with a Norwegian population norm, adjusted for age, gender, and BMI.

Results

Mental summary scores (MCS) and physical summary scores (PCS) were very low preoperatively but significantly improved (P < 0.05) 5 years after surgery. The PCS was comparable to the population norm, while MCS was lower. Depression improved significantly from baseline to the 5-year follow-up (P = 0.004), but anxiety did not (P = 0.595).

Conclusions

This study demonstrates a sustained weight loss and improved, although somewhat fading, HRQL scores 5 years after BPDDS. The study also shows that BPDDS is associated with a sustained reduction in depression symptoms but not in anxiety symptoms.

Physical activity in daily life of patients with fibrotic idiopathic interstitial pneumonia

BACKGROUND

The 6-min walk test (6MWT) is commonly used to assess exercise capacity in patients with fibrotic idiopathic interstitial pneumonia (f-IIP). However, it is not known whether patients with f-IIP have reduced levels of physical activity in daily life (DLPA) or whether pulmonary function tests and the 6MWT correlate with their DLPA.

METHODS

The aim of this study was to measure DLPA in patients with f-IIP and to determine the relationships between DLPA and the 6MWT, pulmonary functional parameters, and anxiety and depression scores. Fifty patients with f-IIP and 25 sex- and age-matched healthy control subjects were enrolled. Markers of DLPA were assessed with a physical activity monitor for 4 consecutive days. Hospital Anxiety and Depression Scale (HADS) scores were evaluated.

RESULTS

DLPA parameters were significantly reduced in patients with f-IIP compared with control subjects (all P < .001). The mean number of steps per day correlated strongly with diffusing capacity of the lung for carbon monoxide (Dlco), FVC, the 6MWT distance, and the 6MWT lowest oxygen saturation as measured by pulse oximetry (Spo₂). DLPA was unrelated to HADS scores. Multivariate analysis showed that Dlco and 6MWT distance explained only 31% of the variance in the number of steps per day. Dlco, 6MWT distance, 6MWT lowest Spo₂, and DLPA were significant predictors of mortality, but only Dlco and 6MWT distance were independent predictors.

CONCLUSIONS

Quantitation of DLPA is a novel patient-centered approach to assess function in f-IIP and may be a useful tool for clinical care and assessing response to therapy.

The Effects of Exercise Training on Anxiety

This review summarizes the extant evidence of the effects of exercise training on anxiety among healthy adults, adults with a chronic illness, and individuals diagnosed with an anxiety disorder. A brief discussion of selected proposed mechanisms that may underlie relations of exercise and anxiety is also provided. The weight of the available empirical evidence indicates that exercise training reduces symptoms of anxiety among healthy adults, chronically ill patients, and patients with panic disorder. Preliminary data suggest that exercise training can serve as an alternative therapy for patients with social anxiety disorder, generalized anxiety disorder, and obsessive–compulsive disorder. Anxiety reductions appear to be comparable to empirically supported treatments for panic and generalized anxiety disorders. Large trials aimed at more precisely determining the magnitude and generalizability of exercise training effects appear to be warranted for panic and generalized anxiety disorders. Future well-designed randomized controlled trials should (a) examine the therapeutic effects of exercise training among understudied anxiety disorders, including specific phobias, social anxiety disorder and posttraumatic stress disorder; (b) focus on understudied exercise modalities, including resistance exercise training and programs that combine exercise with cognitive-behavioral therapies; and (c) elucidate putative mechanisms of the anxiolytic effects of exercise training.