Depression as a powerful discriminator between physically active and sedentary middle-aged men

Relationships among Physical Activity, Health-Related Quality of Life, and Weight Stigma in Children in Hong Kong

Objectives: Our objective in this study was to establish the relationships among active and inactive physical activity, HRQoL, and weight stigma in children. Additionally, we investigated weight stigma as a mediator of the relationship between physical activity and HRQoL.Methods: This cross-sectional study was conducted in Hong Kong (June 2017-July 2018). Participants were 437 children in elementary school (2 primary schools and 2 non-governmental organizations) and their parents (dyads). Participants completed questionnaires containing items assessing demographic characteristics, physical activity level, and several HRQoL measures.Results: We found a statistically significant difference between a higher physically activity group (exercise > 2 hours/week) in all measures of HRQoL. Weight stigma had a significant mediating effect on the relationship between physical activity and child-rated HRQoL (Coefficient = -0.37; SE=0.05; t = 8.21; p < .001), parent-rated HRQoL (Coefficient = -0.16; SE = 0.04; t = 4.21; p < .001), and child-rated weight-related QoL (Coefficient = -0.56; SE = 0.04; t = 14.92; p < .001). Conclusions: Physical activity was associated with better HRQoL and lower weight stigma. Weight stigma appears to affect how physical activity is related to better HRQoL, but the association is somewhat weak.

A Scoping Review of the Relationship between Running and Mental Health

Poor mental health contributes significantly to global morbidity. The evidence regarding physical benefits of running are well-established. However, the mental health impacts of running remain unclear. An overview of the relationship between running and mental health has not been published in the last 30 years. The purpose of this study was to review the literature on the relationship between running and mental health. Our scoping review used combinations of running terms (e.g., Run* and Jog*) and mental health terms (general and condition specific). Databases used were Ovid(Medline), Ovid(Embase), ProQuest and SportDiscus. Quantitative study types reporting on the relationships between running and mental health were included. Database searches identified 16,401 studies; 273 full-texts were analysed with 116 studies included. Overall, studies suggest that running bouts of variable lengths and intensities, and running interventions can improve mood and mental health and that the type of running can lead to differential effects. However, lack of controls and diversity in participant demographics are limitations that need to be addressed. Cross-sectional evidence shows not only a range of associations with mental health but also some associations with adverse mental health (such as exercise addiction). This review identified extensive literature on the relationship between running and mental health.

Aerobic vs anaerobic exercise training effects on the cardiovascular system

Physical exercise is one of the most effective methods to help prevent cardiovascular (CV) disease and to promote CV health. Aerobic and anaerobic exercises are two types of exercise that differ based on the intensity, interval and types of muscle fibers incorporated. In this article, we aim to further elaborate on these two categories of physical exercise and to help decipher which provides the most effective means of promoting CV health.

Physical Activity as a Nonpharmacological Treatment for Depression: A Review

Physical activity is increasingly being cited as an alternative to more traditional drug treatments for treating depression. Although an increasing amount of research has investigated this theory, much of the literature has been criticized from a methodological perspective. Given rising concern for the increasing costs of mental health care, it is timely and important to examine valid, reliable, and objective research findings on the potential role of physical activity as a low-cost non-pharmacological intervention for the treatment of depression. This article reviews cross-sectional, longitudinal, and randomized studies that investigated the role of physical activity in the prevention and alleviation of depression. The review found that although there is undoubtedly a need for more research with a greater emphasis on methodological strength, the scientific literature is generally supportive of the beneficial effects of aerobic and nonaerobic exercise on depression in clinically and nonclinically depressed adults. Implications for public health are discussed.

Influence of Intensity and Duration of Yoga on Anxiety and Depression Scores Associated with Chronic Illness

Background:

Chronic illness is commonly associated with anxiety and depression. Both anxiety and depression respond to yoga. However, there is no report on the association between the intensity and duration of yoga practice with the benefits seen.

Aim:

The present study was intended to determine whether the daily duration of yoga practice and the duration of experience in months would predict anxiety and depression, associated with chronic illness.

Subjects and Methods:

Seven hundred and sixty-three volunteers with ages between 14 and 86 years (group mean age standard deviation, 50.2 [14.2]) who attended a 7 day residential yoga camp in the north of India were included in this cross-sectional study. All participants had chronic illnesses, which were under control with treatment, and which were categorized and are detailed. Participants were assessed for state anxiety scores using State-Trait Anxiety Inventory and for anxiety with hospital anxiety and depression scale (HADS-A), and depression was assessed using HADS-D scores of the HADS. Linear multiple regression analyses were performed using PASW SPSS version 18.0 (Armonk, New York, U.S.) to determine how the daily and monthly duration of yoga practice could influence state anxiety, hospital anxiety and depression of the participants.

Results:

Yoga practice in months and the time spent practicing yoga each day significantly predict the level of state anxiety (P < 0.001, P = 0.03) and HAD-A (P < 0.01, P < 0.01). The duration of yoga practice in months alone was a significant predictor of the HAD-D (P < 0.01).

Conclusions:

The results suggest that the duration of yoga practice in months and daily practice in minutes predict anxiety associated with chronic illness. In contrast the duration of yoga practice in months alone, predicted depression scores.

The promise of wearable activity sensors to define patient recovery

The recent emergence of mobile health--the use of mobile telecommunication and wireless devices to improve health outcomes, services, and research--has inspired a patient-centric approach to monitor health metrics. Sensors embedded in wearable devices are utilized to acquire greater self-knowledge by tracking basic parameters such as blood pressure, heart rate, and body temperature as well as data related to exercise, diet, and psychological state. To that end, recent studies on utilizing wireless fitness activity trackers to monitor and promote functional recovery in patients suggest that collecting up-to-date performance data could help patients regain functional independence and help hospitals determine the appropriate length of stay for a patient. This manuscript examines existing functional assessment scales, discusses the use of activity tracking sensors in evaluating functional independence, and explores the growing application of wireless technology in measuring and promoting functional recovery.

Interactions of sexual activity, gender, and depression with immunity

INTRODUCTION

Depression can suppress immune function, leading to lower resistance against infection and longer healing times in depressed individuals. Sexuality may also influence immune function, with evidence that sexual activity is associated with lowered immune function in women and mixed results in men. Immune mediators like immunoglobulin A (IgA) are immediately relevant to sexual health, since they are the first line of defense against pathogens at mucous membranes like the vagina.

AIM

This study aims to determine if and how depression, sexual activity, and their interaction impact salivary IgA (SIgA) in men and women.

METHODS

In Study 1, a community-based sample of 84 women and 88 men provided saliva samples and completed questionnaires on their demographic background, level of depression, and frequency of partnered and solitary sexual activity. Study 2, conducted separately in an undergraduate student sample of 54 women and 52 men, had similar methods.

MAIN OUTCOME MEASURES

The main outcome measures were scores on the General Well-Being Schedule depression subscale, reported frequency of sexual activity, and SIgA levels as measured by enzyme immunoassay.

RESULTS

Across studies, higher levels of partnered sexual activity were associated with lower SIgA for women with high depression scores, but not for women with low depression scores. In contrast, higher levels of partnered sexual activity were associated with higher SIgA for men with high depression scores, but not for men with low depression scores.

CONCLUSION

Our results show that partnered sexual activity is a risk factor for lowered immunity in women with depressive symptoms but a possible resilience factor for men with depressive symptoms. This suggests a role for sexual activity in determining the impact of depression on physical health parameters.

Depression among the urban poor in Peninsular Malaysia: A community based cross-sectional study

This community based cross-sectional study examined the prevalence and factors associated with depression among urban poor in Peninsular Malaysia. The Patient Health Questionnaire (PHQ-9) was used to determine the presence or absence of depression. The prevalence of depression among the urban poor was 12.3%. Factors significantly associated with depression included respondents under 25 years old, male gender, living in the area for less than four years and those who do not exercise regularly. It is important to identify individuals with depression and its associated factors early because depression can severely affect the quality of life.

Nível de atividade física e estado de humor em adolescentes

Poucos estudos investigaram a relação exercício-humor em adolescentes. O objetivo do presente estudo foi verificar a relação entre o nível de atividade física relatado por adolescentes e o estado de humor, analisando diferenças entre gêneros. Dezessete meninos (M=17,5; DP=1,4 anos) e 24 meninas (M=16,0; DP=2 anos) foram avaliados na escola. Mensurou-se o nível de atividade física habitual (NAFH) e o estado de humor. Verificou-se relação negativa entre o NAFH e o distúrbio total de humor (r = - 0,30, p<0,05), bem como relação positiva entre o NAFH e Vigor (r = 0,48, p<0,01), tanto nas meninas quanto nos meninos. Conclui-se que os participantes que relataram maior nível de atividade física apresentaram melhor escore no estado de humor, independente do gênero.

Changes of serum beta-endorphin by programmed exercise training are correlated with improvement of clinical symptoms and quality of life in female mitral valve prolapse syndrome

BACKGROUND

Mitral valve prolapse (MVP) is a common entity in female population. Although this is a minor disease, it may cause annoying symptoms that impair quality of life (QOL), and no established therapy for this problem. The aim of this study isto examine whether programmed exercise training by treadmill in female MVP syndrome would improve clinical symptoms and QOL.

METHODS

An interventional study of 39 females with MVP syndrome with treadmill exercise endurance training for 12 weeks. Every individual received training for 30 min a day, thrice a week for 12 weeks. Baseline and post-exercise at 12 weeks serum beta-endorphins were measured. Symptom improvement was assessed by the MVP symptom checklist questionnaire and the Euro-QOL-5D was used to measure QOL improvement in these females.

RESULTS

The mean serum beta-endorphin increased from 0.5 to 1.68 ng/ml (p = 0.001) in the exercise group (n = 18) after 12 weeks exercise, whereas the control group (n = 21) did not show any significant changes (0.44 vs. 0.43 ng/ml). Major symptoms of MVP such as chest pain, palpitation, fatigue were improved significantly by the assessment of MVP symptom checklist. The QOL of the exercised females also showed significant changes.

CONCLUSIONS

Through programmed exercise training in these MVP females, the improvement of symptoms and QOL is parallel to the increase of serum beta-endorphin. This result implicates that MVP females should initiate exercise to tackle this annoying problem.

O efeito da assistência psicológica em um programa de reabilitação pulmonar para pacientes com doença pulmonar obstrutiva crônica

OBJETIVO: Avaliar o efeito da psicoterapia sobre os níveis de ansiedade, depressão, qualidade de vida e capacidade de exercício em portadores de doença pulmonar obstrutiva crônica, submetidos a um programa de reabilitação pulmonar. MÉTODOS: Ensaio clínico prospectivo, controlado e cego realizado com 49 portadores de doença pulmonar obstrutiva crônica randomizados em três grupos: programa de reabilitação pulmonar completo (grupo 1), sem exercícios físicos (grupo 2) e sem psicoterapia (grupo 3). Foram utilizados para avaliação: inventários de ansiedade e de depressão de Beck, questionário respiratório de Saint George e o produto da distância caminhada pelo peso. RESULTADOS: Os grupos 1 e 2 demonstraram melhora absoluta estatisticamente significativa na capacidade de realizar exercícios (p = 0,007, p = 0,008 e p = 0,06, respectivamente). Os grupos 1 e 2 demonstraram redução significativa dos níveis de ansiedade e depressão, e melhora no índice de qualidade de vida: grupo 1 - p = 0,0000, p < 0,0003 e p = 0,0007; e grupo 2 - p = 0,0001, p = 0,0014 e p = 0,002, respectivamente. O grupo 3 demonstrou redução no nível de ansiedade (p = 0,03), mas não no nível de depressão e no índice de qualidade de vida, significativamente. CONCLUSÃO: Sessões de psicoterapia num programa de reabilitação pulmonar auxiliaram portadores de doença pulmonar obstrutiva crônica no manejo das limitações impostas pela doença, através da redução dos níveis de sintomas comportamentais, especialmente depressão, influindo na melhora da capacidade de realizar exercícios físicos e na qualidade de vida relacionada à saúde.

Psychosocial factors and cardiovascular diseases

Rapidly accruing evidence from a diversity of disciplines supports the hypothesis that psychosocial factors are related to morbidity and mortality due to cardiovascular diseases. We review relevant literature on (a) negative emotional states, including depression, anger and hostility, and anxiety; (b) chronic and acute psychosocial stressors; and (c) social ties, social support, and social conflict. All three of these psychosocial domains have been significantly associated with increased risk of cardiovascular morbidity and mortality. We also discuss critical pathophysiological mechanisms and pathways that likely operate in a synergistic and integrative way to promote atherogenesis and related clinical manifestations. We conclude by discussing some of the important challenges and opportunities for future investigations.

Cardiorespiratory fitness and risk of disability pension: a prospective population based study in Finnish men

BACKGROUND

Early retiring is a major social problem in many western countries.

AIM

To investigate whether good cardiorespiratory fitness prevents disability pensioning in Finnish middle-aged men.

METHODS

Subjects were a random population based sample of 1307 men who were 42-60 years old at baseline, had not retired before baseline or died during follow up, and had undergone a cycle ergometer test at baseline. Cardiorespiratory fitness was assessed at baseline with a maximal but symptom limited exercise test on an electrically braked cycle ergometer.

RESULTS

During a follow up of 11 years on average, 790 (60.4%) men were awarded a disability pension, only 254 (19.4%) men reached the old-age pension without previous early pension, and 263 (20.1%) men were still working at the end of follow up. After adjustment for age, body mass index, alcohol consumption, smoking, education, occupation, and baseline chronic diseases, an inverse association was observed between cardiorespiratory fitness and the risk of disability pension. Men with VO2max <25.98 ml/kg/min (lowest fifth) had a 3.28-fold (95% CI 1.70 to 6.32) and men with the duration of exercise test <9.54 minutes (lowest fifth) had a 4.66-fold (95% CI 2.43 to 8.92) risk of disability pension due to cardiovascular diseases compared with men in the highest fifths. Men with lowest fitness level also had an increased risk of disability pension due to musculoskeletal disorders, or all reasons combined.

CONCLUSIONS

Physical fitness is inversely associated with the risk of disability pension and especially with the risk of disability due to cardiovascular diseases.

A randomized controlled trial of the effect of psychotherapy on anxiety and depression in chronic obstructive pulmonary disease

OBJECTIVE

To assess the effect of psychotherapy on the anxiety and depression levels of patients with chronic obstructive pulmonary disease (COPD).

DESIGN

A blind, randomized, controlled trial.

SETTING

Outpatient university pulmonary rehabilitation program in Brazil.

PARTICIPANTS

Thirty patients with COPD (mean age, 60.33y; 22 men) attending a pulmonary rehabilitation program were randomized into 2 groups: experimental group (G1) and control group (G2). Both groups underwent a 12-week treatment program.

INTERVENTIONS

Group 1 (n=14) participated in 24 sessions of physical exercise, 24 sessions of physiotherapy, 12 psychologic sessions, and 3 educational sessions. Group 2 did not participate in psychotherapy sessions.

MAIN OUTCOME MEASURES

All patients were evaluated at baseline and at completion of the pulmonary rehabilitation program by using 3 instruments: the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and 6-minute walk distance (6MWD).

RESULTS

Both groups showed statistically significant improvements on the 6MWD (G1, P<.001; G2, P=.03). Only G1 had a significant reduction in anxiety and depression levels (G1: BAI, P<.001; BDI, P<.001; G2: BAI, P=.156; BDI, P=.142). Statistically significant differences existed between G1 and G2 for BAI (P<.001) and BDI (P=.02).

CONCLUSIONS

Including psychotherapy in a pulmonary rehabilitation program for COPD reduced patients' anxiety and depression levels but did not modify 6MWD performance.

Prospective association between obesity and depression: evidence from the Alameda County Study

OBJECTIVE

To examine the temporal relation between obesity and depression to determine if each constitutes a risk factor for the other.

DESIGN

A two-wave, 5-y-observational study with all measures at both times.

SUBJECTS

A total of 2123 subjects, 50 y of age and older, who participated in the 1994 and 1999 waves of the Alameda County Study.

MEASUREMENTS

Obesity defined as body mass index (BMI)> or =30. Depression assessed using DSM-IV symptom criteria for major depressive episodes. Covariates include indicators of age, gender, education, marital status, social support, life events, physical health problems, and functional limitations.

RESULTS

Obesity at baseline was associated with increased risk of depression 5 y later, even after controlling for depression at baseline and an array of covariates. The reverse was not true; depression did not increase the risk of future obesity.

CONCLUSION

These results, the first ever on reciprocal effects between obesity and depression, add to a growing body of evidence concerning the adverse effects of obesity on mental health. More studies are needed on the relation between obesity and mental health and implications for prevention and treatment.

Are the fat more jolly?

Does obesity affect mental health? Two waves of data from a panel study of community residents 50 years and older were used to investigate the association between obesity and eight indicators of mental health: happiness, perceived mental health, life satisfaction, positive affect, negative affect, optimism, feeling loved and cared for, and depression. For none of the eight mental health outcomes examined did we observe a protective effect for obesity. Either no association was observed between obesity and psychological functioning, or the obese were worse off. Using 1994-1999 prospective data, the obese were at increased risk for poorer mental health on five of the outcomes examined using bivariate analyses. However, controlling for mental health problems at baseline and using statistical controls for covariates, the increased relative risk was limited to depression. There has been sufficient disparity of results thus far to justify further research on this question.

Physical activity in aging: changes in patterns and their relationship to health and function

Sedentary behavior is an important risk factor for chronic disease morbidity and mortality in aging. However, there is a limited amount of information on the type and amount of activity needed to promote optimal health and function in older people. The purpose of this review is to describe the change in patterns of habitual physical activity in aging and the relationship of these changes to physical function and selected chronic diseases. We undertook a literature review of large population-based studies of physical activity in older people, and there is encouraging evidence that moderate levels of physical activity may provide protection from certain chronic diseases. Additionally, substantial health effects can be accrued independent of the fitness effects achieved through sustained vigorous activity. Thus, regular participation (i.e., 30 minutes/day on most days of the week) in activities of moderate intensity (such as walking, climbing stairs, biking, or yardwork/gardening), which increase accumulated daily energy expenditure and maintain muscular strength, but may not be of sufficient intensity for improving fitness, should be encouraged in older adults. Public policy should focus on ways of increasing volitional and lifestyle activity in older people, as well as on increasing the availability and accessibility of senior and community center programs for promoting physical activity throughout the life span.

Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months

OBJECTIVE

The purpose of this study was to assess the status of 156 adult volunteers with major depressive disorder (MDD) 6 months after completion of a study in which they were randomly assigned to a 4-month course of aerobic exercise, sertraline therapy, or a combination of exercise and sertraline.

METHODS

The presence and severity of depression were assessed by clinical interview using the Diagnostic Interview Schedule and the Hamilton Rating Scale for Depression (HRSD) and by self-report using the Beck Depression Inventory. Assessments were performed at baseline, after 4 months of treatment, and 6 months after treatment was concluded (ie, after 10 months).

RESULTS

After 4 months patients in all three groups exhibited significant improvement; the proportion of remitted participants (ie, those who no longer met diagnostic criteria for MDD and had an HRSD score <8) was comparable across the three treatment conditions. After 10 months, however, remitted subjects in the exercise group had significantly lower relapse rates (p = .01) than subjects in the medication group. Exercising on one's own during the follow-up period was associated with a reduced probability of depression diagnosis at the end of that period (odds ratio = 0.49, p = .0009).

CONCLUSIONS

Among individuals with MDD, exercise therapy is feasible and is associated with significant therapeutic benefit, especially if exercise is continued over time.

Are the obese at greater risk for depression?

Two waves of data from a community-based study (Alameda County Study, 1994-1995) were used to investigate the association between obesity and depression. Depression was measured with 12 items covering Diagnostic and Statistical Manual of Mental Disorders: DSM-IV diagnostic criteria for major depressive episode. Following US Public Health Service criteria, obese subjects were defined as those with body mass index scores at the 85th percentile or higher. Covariates were age, sex, education, marital status, social isolation and social support, chronic medical conditions, functional impairment, life events, and financial strain. Results were mixed. In cross-sectional analyses, greater odds for depression in 1994 were observed for the obese, with and without adjustment for covariates. When obesity and depression were examined prospectively, controlling for other variables, obesity in 1994 predicted depression in 1995 (odds ratio (OR) = 1.73, 95% confidence interval (CI): 1.04, 2.87). When the data were analyzed with obesity defined as a body mass index of > or = 30, cross-sectional results were the same. However, the prospective multivariate analyses were not significant (OR = 1.43, 95% CI: 0.85, 2.43). Although these data do not resolve the role of obesity as a risk factor for depression, overall the results suggest an association between obesity and depression. The authors found no support for the "jolly fat" hypothesis (obesity reduces risk of depression). However, there has been sufficient disparity of results thus far to justify continued research.

Hypertension incidence is predicted by high levels of hopelessness in Finnish men

Recent studies have reported that hopelessness is an important factor in cardiovascular morbidity and mortality, including ischemic heart disease, acute myocardial infarction, and atherosclerotic progression. This study examined the relationship between hopelessness and incident hypertension in a population-based sample of 616 initially normotensive, middle-aged men from eastern Finland, an area with high rates of cardiovascular disease. Participants completed a medical examination and a series of psychological questionnaires at baseline and at the 4-year follow-up. Hopelessness was measured by 2 items assessing negative expectancy about the future and one's goals. A logistic regression model with adjustments for age, body mass index, baseline resting blood pressure, physical activity, smoking, alcohol consumption, education, parental history of hypertension, and self-reported depressive symptoms revealed that men reporting high levels of hopelessness at baseline were 3 times more likely to become hypertensive (systolic blood pressure > or =165 mm Hg and/or a diastolic blood pressure > or =95 mm Hg or confirmed use of antihypertensive medication) in the intervening 4 years than men who were not hopeless (odds ratio, 3.22; 95% confidence interval, 1. 56, 6.67). Men reporting moderate levels of hopelessness were not at a significantly increased risk of hypertension (odds ratio, 1.27; 95% confidence interval, 0.79, 2.07). This is the first study to identify a significant relationship between hopelessness and incident hypertension. Research is needed to explore the neuroendocrine and central nervous system mechanisms underlying this association.

The effect of exercise and diet on mental health and quality of life in middle-aged individuals with elevated risk factors for cardiovascular disease

Mental health and quality of life were assessed before and after a one-year exercise and diet intervention among 219 healthy individuals, aged 41-50 years, with elevated risk factors for cardiovascular disease. The participants were randomized to four groups: diet (n = 55), diet and exercise (n = 67), exercise (n = 54) and no active intervention (n = 43). Quality of life was measured with one eight-item scale and two one-item scales. Mental health was measured by the General Health Questionnaire (30-item version). Depression, anxiety, feelings of competence and self-esteem, coping and social dysfunction were measured using subscales of the General Health Questionnaire. Somatic anxiety was measured by the anxiety subscale of the Symptom Check List-90. Exercise improved the total GHQ scores, perceived competence/self-esteem, and coping as measured by the GHQ subscales. There were no significant effects of diet or exercise on quality of life, depression or anxiety. A high rate of participation in the exercise programme (>70%) was associated with greater improvements in total GHQ scores, anxiety, perceived competence/self-esteem and coping.

Effect of exercise training on quality of life in patients with chronic heart failure

The effect of exercise training on quality of life and exercise capacity was studied in 67 patients with mild to moderate chronic heart failure (CHF; age: 65.6+/-8.3 years; left ventricular ejection fraction: 26.5+/-9.6%). Patients were randomly allocated to either a training group or to a control group. After intervention a significantly larger decrease in Feelings of Being Disabled (a subscale of the Heart Patients Psychological Questionnaire) and a significantly larger increase in the Self-Assessment of General Well-Being (SAGWB) were observed in the training group. Exercise time and anaerobic threshold were increased in the training group only. The increase in exercise time was related to both Feelings of Being Disabled and SAGWB. We conclude that supervised exercise training improves both quality of life and exercise capacity and can be safely performed by chronic heart failure patients.

Exercise and its role in the prevention and rehabilitation of cardiovascular disease

The purpose of this article is to review the beneficial effects of regular exercise in the primary and secondary prevention of coronary artery disease (CAD). Epidemiologic studies indicate that a physically inactive life-style is associated with twice the risk of developing CAD. The magnitude of risk is similar to that of other modifiable risk factors. Meta-analysis of studies of cardiac rehabilitation after myocardial infarction demonstrate that cardiac rehabilitation participants lower their risk of death by 20% to 25% compared to controls. Exercise training results in several beneficial physiological changes including an increase in exercise endurance, higher resting and exercise stroke volumes, lower resting and submaximal exercise heart rates, and increased capillary density and oxidative enzyme capacity in skeletal muscle. In patients with established CAD, exercise training improves symptoms of angina and congestive heart failure and attenuates the severity of exercise-induced ischemia. Regular exercise can favorably modify other risk factors, but the benefits are modest. Reductions in systolic and diastolic blood pressure readings average 6 to 9 mm Hg; decreases in total and low-density lipoprotein (LDL) cholesterol approximate 5 to 10 mg/dL; and increases in high-density lipoprotein (HDL) cholesterol approximate 2 mg/dL. Exercise training as a sole intervention does not appear to enhance smoking cessation. Regular exercise does improve psychosocial well-being. Most studies of physical activity have enrolled predominantly middle-aged men; however, available evidence suggests similar cardiovascular benefits for women, the elderly, and children and youth. Physical activity levels decrease substantially during the school-age-adolescent transition in both males and females. More than half of the adult population is sedentary or inactive. Collectively, accumulated data suggest the need for both individualized/high-risk and population-based approaches to increasing physical activity across the life span.

Health-related behaviours and psycho-social characteristics of 18 year-old Australians

Psychosocial variables associated with health-related behaviours for diet, physical activity, alcohol consumption and smoking were examined in 18 year-old Australian men (n = 301) and women (n = 282). These psychosocial variables included Type A behaviour and depression, perceived self-efficacy for engaging in healthy behaviours and perceived barriers to performing these behaviours. Self-efficacy for following a healthy diet and moderating alcohol intake was greater in females but males had higher self-efficacy for physical activity. Self-efficacy for smoking did not differ according to gender. Lack of willpower was perceived as a barrier to desirable dietary, smoking and physical activity behaviours. Other perceived diet-related barriers included buying suitable foods when eating out, ignorance about appropriate foods and, in young women, perceived expense. Barriers for desirable levels of physical activity included planning time, tiredness, limiting social life and lack of social support. Social occasions were the main perceived barriers preventing both alcohol moderation and quitting smoking. Lack of family support, stress and concerns about weight gain, particularly in women, were perceived barriers to smoking cessation. Type A behaviour was associated with smoking and "unsafe" drinking in both men and women, generally unhealthy dietary choices in young women but with greater physical activity in young men. Depressive affect was significantly higher in female smokers and "unsafe" drinkers and tended to have an inverse relationship with physical activity in men and women. Depressive affect was inversely related to self-efficacy in both men and women for each of the health behaviours examined. Health promotion in young adults should therefore attempt to increase self-efficacy and address perceived barriers to change, taking into account gender-related differences in attitudes and the influence of depression and Type A characteristics on health-related behaviours.

The effect of moderate exercise on mood in mildly hypertensive volunteers: a randomized controlled trial

This study reports an investigation of the effect of participating in moderate exercise (three 40-min sessions of brisk walking a week for 6 months) on mood state in 177 sedentary, mildly hypertensive volunteers. Mood was assessed by the Profile of Mood States, Bipolar Form (POMS-BI), and no significant differences were found between control and exercise groups. The intervention group increased its exercise output more than the control group, but there was also a significant increase in exercise done by the control group. We conclude that exercise has no major effect on mood in hypertensive volunteers.

Depressive symptoms in overweight and obese older adults: a test of the "jolly fat" hypothesis

The association between body weight and depressive symptoms in older adults was examined in a population-based study of 2,245 noninstitutionalized men and women aged 50 to 89 years living in Rancho Bernardo, California, U.S.A. The prevalence of Beck Depression Inventory scores > or = 13 was inversely associated with body weight in men, but not in women. Overweight and obese 50- to 69-yr-old women were more depressed than women with a body mass index below 25 kg/m2, but the difference was only marginally significant (p = 0.09). When age, health status and medication use were controlled, the odds of being depressed were 0.34 (p = 0.004) in overweight men and 0.28 (p = 0.09) in obese men, compared to men with a body mass index below 25 kg/m2. In this cohort, depression in men was inversely associated with body weight, supporting the "Jolly Fat" hypothesis. The likelihood that more stigma is attached to excessive weight in women than men may account for the lack of an inverse association between weight and depression in women.

Exercise maintenance of persons with arthritis after participation in a class experience

This study investigated factors related to an initial exercise experience to explain exercise maintenance in 120 adults with rheumatoid arthritis or osteoarthritis. Integral secondary analysis was used to incorporate data from a prospective, controlled trial of exercise (Minor et al.: Arthritis Rheum 32:1396, 1989) with data collected at 18 months follow-up. The dependent variable was self-directed exercise (min/wk) reported at 3, 9, and 18 or more months after exercise class participation. Predictor variables included physical, psychosocial, disease, and programmatic factors. The all possible regressions search procedure resulted in three explanatory models (p = .0001). At 3 months the model (R2 = .45) included initial aerobic capacity, depression, and anxiety; and changes in depression and social activity. The 9-month model (R2 = .35) consisted of initial anxiety and physical activity, change in depression, support of friends for exercise, and exercise behavior at prior assessment. At 18 or more months (R2 = .42), model variables were initial aerobic capacity, change in pain, and exercise behavior at the two prior assessments. Neither disease nor program factors appeared as significant. This limited study indicates that factors associated with exercise behavior in this sample are similar to those in the general population; explanatory factors change over time, and changes ascribed to a trial behavior may influence subsequent decision making.

The effects of moderate exercise training on psychological well-being and mood state in women

The relationship between moderate exercise training (five 45 min sessions/week, brisk walking at 62 beta +/- 2% VO2max for 15 weeks, psychological well-being and mood state was investigated in a group of 35 sedentary, mildly obese women. A 2 (exercise (EX) (N = 18), and nonexercise (NEX) (N = 17) groups) x 3 (baseline, 6-week, 15-week testing sessions) factorial design was used with data analyzed using repeated measures ANOVA. Four psychological tests were administered: Daily Hassles Scale (DHS), General Well-being Schedule (GWB), Spielberger State Anxiety Inventory (S-Anxiety), and Profile of Mood States (POMS). The EX and NEX groups had significantly different patterns of change over time for GWB total scores [F(2,66) = 5.72, p = 0.005] and the GWB subscales 'energy level' and 'freedom from health concern or worry'. Scores for the EX group were elevated at both 6 and 15 weeks. General well-being total scores and subscale 'energy level' scores were significantly correlated with improvement in submaximal cardiorespiratory fitness (r = -0.41, p = 0.014; r = -0.40, p = 0.017, respectively). Exercise training also had a significant effect on frequency but not intensity of DHS scores, and S-Anxiety, with a significant decrease seen in the EX group at 6 weeks but not 15 weeks. Profile of Mood States scores were not significantly related to exercise training. These data support the results of other studies that have reported improvement in general psychological well-being with exercise training.

Depression and acute myocardial infarction: a review and reinterpretation

Depression is widely accepted as occurring in response to acute myocardial infarction (AMI), and to be an important determinant of recovery. A review of the literature reveals that three categories of patients with depressive symptomatology may be identifiable. First, many patients show depressive symptoms before admission with AMI; these may intensify during hospitalisation. For these patients, the depressive symptoms may contribute etiologically to the onset of AMI or derive from a common source along with AMI. The second group constitute patients with a history of AMI, and who on readmission with chest pain or suspected AMI are more likely to report depressive symptoms. The third group of patients are non-depressed first time admissions for AMI. These patients appear to show transient depressive reactions, much of which it is argued, occurs as a reaction to hospitalisation and not to AMI per se. This review considers the theoretical context whereby depressive symptoms may arise from the same circumstances that generate the coronary heart disease which underlies AMI, and links this to the generation of helplessness and cardiopathic processes.

Sport participation and perceived health status: a study of adolescents

Although it is a well-accepted notion that sport participation enhances health, the precise nature of the relationship has been unclear. Based on a national survey of Icelandic adolescents, this study evaluates the direct and indirect effects of sport participation on perceived health status. It is shown that sport participation has a substantial direct effect on perceived health, controlling for other health related behaviours, psychological distress and disease status. Sport participation also affects perceived health indirectly through distress and smoking, but does not seem to operate through alcohol consumption. The meaning of these results and their implications for future research are discussed.

Beta-endorphin and components of emotionality discriminate between physically active and sedentary men

Differences between physically active and sedentary men were tested by profile comparison. The study identifies the relative importance of circulating beta-endorphin (BE), atherosclerotic disease risk (ADR) index, and selected components of emotionality in discriminating between physically active and sedentary men. The subjects were psychologically normal and medically healthy middle-aged men. Jogging activity was the subject classification criterion. The data were collected on selected physiological (treadmill), biochemical (blood collected from resting subjects), and psychological (Eysenck and MMPI) variables. The physical fitness score (PFS) was used as an index of fitness. Physically active men with a high PFS (n = 21), when compared to the sedentary men with a low PFS (n = 15), exhibited lower basal plasma BE, lower ADR, lower anxiety index (AI), and lower MMPI depression score (D). Canonical correlation analysis showed that PFS and BE in one set were correlated with D and neuroticism (NS) in another set of variables. Discriminant function analysis showed that the AI was the most powerful discriminator between the physically active and sedentary men, followed by BE and NS. Interestingly, BE and NS exhibited the same magnitude of discrimination power. The ADR exhibited less discrimination power, relative to AI, BE, and NS. In conclusion, the physically active men, compared to the sedentary men in this study, exhibited lower basal plasma BE, which appeared to be associated with less atherosclerotic disease risk, less neuroticism, less anxiety, and less depression.

Beta-endorphin and components of depression as powerful discriminators between joggers and sedentary middle-aged men

This study identifies the relative importance of resting plasma beta-endorphin, used as a marker of perceived stress, and components of non-clinical depression that discriminate between physically active joggers and sedentary men. The profiles of joggers (n = 10) and sedentary (n = 10) middle-aged men (40-60 yr) were compared. The jogger group had been running about 20 miles per week for at least 3 yr.

RESULTS

as expected, the joggers exhibited greater physical fitness, but lower circulating beta-endorphin (measured with the subjects at rest). The joggers also exhibited greater emotional stability (Eysenck scores), and lower depression (MMPI Scale 2 scores). In addition, the joggers had lower scores on MMPI subscales of depression: subjective depression, physical malfunctioning, mental dullness, and brooding. Multivariate discriminant function analyses showed that subjective depression, beta-endorphin, and physical malfunctioning were powerful discriminators between the jogger and sedentary groups.

IN CONCLUSION

(1) subjective depression appeared to be the MMPI component of depression that most powerfully discriminated between joggers and sedentary middle-aged men in this study. (2) Lower beta-endorphin may be an adaptation to exercise training and was related to greater emotional stability and lower depression, especially lower subjective depression. (3) The lower beta-endorphin in the jogger group may be related to lower perceived stress in the joggers, relative to the sedentary group.

Medical psychology in exercise and sport

Several psychological outcomes that accompany acute and chronic exercise have medical significance. Transient reductions in somatic tension and subjective anxiety appear most reliable. Symptom abatement in moderate depression can occur with chronic exercise in a manner comparable to psychotherapy and may offer a better prognosis in some instances. Other cognitive, behavioral, and perceptual events associated with exercise may assist in managing mental health, and exercise has been successfully used as a therapeutic adjunct in a variety of psychiatric disorders. Regular exercise may also complement treatments designed to manage aspects of coronary-prone behavior and psychoendocrine responsivity to mental stress. The lack of strict experimental control or effective placebo contrasts in most exercise studies precludes a convincing argument that exercise causes the psychological outcomes observed. Rather, expectancy of benefits, generalized treatment or attention effects, social reinforcement, and past history or selection bias represent likely alternatives. These competing explanations do not discount, however, that many individuals benefit in a clinically significant way. Exercise offers a low-cost alternative or adjunct with side effects that appear largely health-related. Although the effective psychological dosage or modality has not been quantified, current physiologic guidelines of the American College of Sports Medicine (large muscle rhythmic activity, for 20 to 60 minutes, 3 to 5 days per week at 60 to 80 per cent age-adjusted maximal heart rate), or a weekly caloric cost of 2000 kcal, should be effective with little medical risk. However, no evidence confirms that an increase in metabolic or psychoendocrine tolerance to exercise is necessary or sufficient for psychological outcomes to occur. Although biologic adaptations are known to follow exercise training and subside with diminished activity, there is currently no objective evidence that habitual exercise leads to dependence. If exercise has use in managing subjective or somatic symptoms, these may return during periods of exercise abstinence. Moreover, despite popular hypotheses concerning endorphins and biogenic amines, no direct relationships have yet been shown between exercise-induced mood swings and peripheral biochemical events. A proportion of habitual runners have reported acute episodes of euphoria-like states during or following exercise, but this remains a subjective and unpredictable event that may be related to psychophysiologic relaxation or acute changes in self-esteem.(ABSTRACT TRUNCATED AT 400 WORDS)

Influence of catecholamine activity on the hierarchical relationships among physical fitness condition and selected personality characteristics

Tested male Ss (N = 34) to determine how changes in the urinary excretion patterns of selected catecholamines and their metabolites affect the multivariate relationships involving variables that measure physical fitness condition and selected personality characteristics. Urine specimens were collected from each S after sleep and during occupational activities and analyzed for six catecholamine-related variables. Those measures were combined with six personality variables (MMPI) and a physical fitness score (Ismail Criterion), and subjected to first- and second-order factor analyses. The findings indicated an association between low physical fitness and high self-reported anxious depression during the occupational period, but not at rest. The changes in the factor structures were statistically mediated by changes in the concentrations of the biochemical variables across the collection periods. This suggests that the relationships between physical fitness and personality are augmented during catecholamine reactivity to occupational stress.