Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes

BACKGROUND

Exercise may improve neuropsychiatric and cognitive symptoms in people with mental disorders, but the totality of the evidence is unclear. We conducted a meta-review of exercise in (1) serious mental illness (schizophrenia spectrum, bipolar disorder and major depression (MDD)); (2) anxiety and stress disorders; (3) alcohol and substance use disorders; (4) eating disorders (anorexia nervosa bulimia nervosa, binge eating disorders, and (5) other mental disorders (including ADHD, pre/post-natal depression).

METHODS

Systematic searches of major databases from inception until 1/10/2018 were undertaken to identify meta-analyses of randomised controlled trials (RCTs) of exercise in people with clinically diagnosed mental disorders. In the absence of available meta-analyses for a mental disorder, we identified systematic reviews of exercise interventions in people with elevated mental health symptoms that included non-RCTs. Meta-analysis quality was assessed with the AMSTAR/+.

RESULTS

Overall, we identified 27 systematic reviews (including 16 meta-analyses representing 152 RCTs). Among those with MDD, we found consistent evidence (meta-analyses = 8) that exercise reduced depression in children, adults and older adults. Evidence also indicates that exercise was more effective than control conditions in reducing anxiety symptoms (meta-analyses = 3), and as an adjunctive treatment for reducing positive and negative symptoms of schizophrenia (meta-analyses = 2). Regarding neurocognitive effects, exercise improved global cognition in schizophrenia (meta-analyses = 1), children with ADHD (meta-analyses = 1), but not in MDD (meta-analyses = 1). Among those with elevated symptoms, positive mental health benefits were observed for exercise in people with pre/post-natal depression, anorexia nervosa/bulimia nervosa, binge eating disorder, post-traumatic stress disorder and alcohol use disorders/substance use disorders. Adverse events were sparsely reported.

CONCLUSION

Our panoramic meta-overview suggests that exercise can be an effective adjunctive treatment for improving symptoms across a broad range of mental disorders.

Cross-sectional and prospective relationships of passive and mentally active sedentary behaviours and physical activity with depression

BACKGROUND

Sedentary behaviour can be associated with poor mental health, but it remains unclear whether all types of sedentary behaviour have equivalent detrimental effects.

AIMS

To model the potential impact on depression of replacing passive with mentally active sedentary behaviours and with light and moderate-to-vigorous physical activity. An additional aim was to explore these relationships by self-report data and clinician diagnoses of depression.

METHOD

In 1997, 43 863 Swedish adults were initially surveyed and their responses linked to patient registers until 2010. The isotemporal substitution method was used to model the potential impact on depression of replacing 30 min of passive sedentary behaviour with equivalent durations of mentally active sedentary behaviour, light physical activity or moderate-to-vigorous physical activity. Outcomes were self-reported depression symptoms (cross-sectional analyses) and clinician-diagnosed incident major depressive disorder (MDD) (prospective analyses).

RESULTS

Of 24 060 participants with complete data (mean age 49.2 years, s.d. 15.8, 66% female), 1526 (6.3%) reported depression symptoms at baseline. There were 416 (1.7%) incident cases of MDD during the 13-year follow-up. Modelled cross-sectionally, replacing 30 min/day of passive sedentary behaviour with 30 min/day of mentally active sedentary behaviour, light physical activity and moderate-to-vigorous activity reduced the odds of depression symptoms by 5% (odds ratio 0.95, 95% CI 0.94-0.97), 13% (odds ratio 0.87, 95% CI 0.76-1.00) and 19% (odds ratio 0.81, 95% CI 0.93-0.90), respectively. Modelled prospectively, substituting 30 min/day of passive with 30 min/day of mentally active sedentary behaviour reduced MDD risk by 5% (hazard ratio 0.95, 95% CI 0.91-0.99); no other prospective associations were statistically significant.

CONCLUSIONS

Substituting passive with mentally active sedentary behaviours, light activity or moderate-to-vigorous activity may reduce depression risk in adults.

Exergames in people with major neurocognitive disorder: a systematic review

PURPOSE

To systematically evaluate the efficacy of exergames in individuals with major neurocognitive disorder.

MATERIALS AND METHODS

PubMed, EMBASE and PEDro were systematically searched from inception until October 2019 for randomised and clinical controlled trials. Methodological quality of the trials was assessed with the PEDro rating scale or Risk of Bias in Nonrandomised Studies of Interventions-I (ROBINS-I), when appropriate. Grading of Recommendations Assessments, Development and Evaluation (GRADE) was used to assess the overall quality of the evidence.

RESULTS

Eight trials, all of moderate to high methodological quality (i.e., PEDro score of 6 or higher or a Robins-I moderate quality score) were included. The overall quality of evidence was moderate to high according to the GRADE criteria. Improvements in gait, mobility and balance and beneficial effects on activities of daily living performance, cognitive function, fear of falls, quality of life and mood following exergaming were reported. Heterogeneity in outcome measures, intervention characteristics and included participants precluded a meta-analysis.

CONCLUSIONS

The current literature is of moderate to high quality and demonstrates that exergames have a wide range of physical and mental benefits in people with major neurocognitive disorder. More controlled trials are however needed to confirm the existing evidence before exergames can be recommended in treatment guidelines for people with major neurocognitive disorder.Implications for rehabilitationExergames have many physical and mental benefits in people with major neurocognitive disorderExergaming can enhance gait, mobility and balance in people with major neurocognitive disorderEvidence for beneficial cognitive effects of exergaming is emerging.

Correlates of physical activity stages of change in people living with HIV in a Ugandan community

Purpose: The transtheoretical model (TTM) of behavioral change posits that individuals move through five stages of change when adopting new behaviors: pre-contemplation, contemplation, preparation, action, and maintenance. The aim of this study was to determine the proportion of patients with HIV/AIDS within a Ugandan fishing community in the different physical activity (PA) stages. We also explored differences in variables, motives, and barriers for PA across the stages.Methods: In total, 256 individuals (77 men, 40.5 ± 10.3 years) completed the Patient-centered Assessment and Counseling for Exercise Questionnaire, the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptoms, and the Alcohol Use Disorders Identification Test. They were also asked about their most important PA motive and barrier.Results: Seventy-five individuals (29%) were in the (pre-)preparatory stages, 140 (55%) in the action and 41 (16%) in the maintenance stage. Those in the (pre-)preparatory stages had higher PHQ-9 total scores (p < 0.001) and were more likely to report barriers than those in the later stages (p < 0.001). Compared with those in the (pre-)preparatory stage, patients in the action stage experienced less body weakness (p = 0.015).Conclusions: Depression and barriers to PA should be considered in people with HIV/AIDS in low-resource settings when implementing interventions to assist them to become more active.Implications for rehabilitationPeople with HIV/AIDS are among the most physically inactive clinical populations.Clinicians should consider depression when motivating patients with HIV in low resourced settings to become active.Clinicians should consider body weakness when motivating patients with HIV in low resourced settings to become active.

Associations of interruptions to leisure-time sedentary behaviour with symptoms of depression and anxiety

Interruptions to time spent sitting can ameliorate detrimental metabolic-health consequences of high volumes of sedentary time, but their potential mental health benefits have not been examined. We used the Swedish Health Profile Assessment database, a general health assessment offered to all employees working for companies or organisations connected to occupational and health services. Cross-sectional analyses examined data from 40,550 employees (60% male, mean age = 42 years), collected in 2017-2019. Participants reported the proportion of time (almost always; 75% of the time; 50% of the time; 25% of the time; and almost never) usually spent in leisure-time sedentary behaviours; and, separately, the frequency (never; rarely; sometimes; often; and very often) of interruptions (every 30 min) to sedentary time. Logistic regression models assessed associations of sedentary time, and the frequency of interruptions to sedentary time, with depression/anxiety symptoms. Fully adjusted models included physical exercise. Compared to those in the lowest sedentary time category, those in the medium and high categories had 1.52 (95% confidence interval (CI) = 1.40-1.66) and 3.11 (95% CI = 2.82-3.42) higher odds of frequent depression/anxiety symptoms, respectively. Compared to those who never/rarely interrupted their sedentary time, those who reported interruptions sometimes, often and very often had 0.72 (95% CI = 0.65-0.80), 0.59 (95% CI = 0.53-0.65), and 0.53 (95% CI = 0.46-0.59) lower odds of depression/anxiety symptoms, respectively. In stratified analyses, more frequent interruptions to sedentary time were associated with lower odds of depression/anxiety symptoms, except among those in the lowest interruptions categories (never/25% of the time). More regularly interrupting sitting during leisure-time may reduce the odds of experiencing symptoms of depression and anxiety.

Sexual behavior and suicide attempts among adolescents aged 12-15 years from 38 countries: A global perspective

BACKGROUND

The aim was to investigate the relationship between sexual behaviors and suicide attempts by using data from 38 countries from four World Health Organization regions.

METHODS

Cross-sectional data from 116,820 adolescents aged 12-15 years participating in the Global School-based Student Health Survey 2009-2016 were analyzed. Data on sexual behaviors were collected: (i) ever having had intercourse; among those who reported having had intercourse, (ii) multiple (≥2) lifetime sexual partners and (iii) condom use in last sexual intercourse and past 12-month suicide attempts were self-reported. Associations were analyzed using multivariable logistic regression.

RESULTS

The prevalence of sexual intercourse and suicide attempts were 13.2% and 9.1%, respectively. A positive association between sexual intercourse and suicide attempts was found in 32 of the 38 countries (pooled OR for whole sample 2.12 [95% CI 1.98-2.27]). Having had multiple sexual partners was associated with increased odds of suicide attempts (pooled OR for whole sample 1.58 [1.27-1.96]). Condom non-use was only associated with suicide attempts among boys in the Americas (OR: 1.75 [1.25-2.45]).

CONCLUSION

Engaging in sexual intercourse was associated with increased risk of suicide attempt. Moreover, having had multiple sexual partners may also increase the risk of suicide attempts.

Functioning in schizophrenia: a Delphi study covering the perspective of physiotherapists

PURPOSE

This qualitative study explores the barriers, personal characteristics/resources, and environmental factors that experienced physiotherapists identify as relevant in the assessment and treatment of persons living with schizophrenia, and whether the identified aspects are represented in the International Classification of Functioning, Disability and Health Core Sets for schizophrenia.

METHODS

A three-round Delphi study with physiotherapists was conducted between April and July 2018. In the first round, participants had to list all the aspects they considered to be relevant when assessing and/or treating individuals with schizophrenia, and they were asked six open-ended questions. Their responses were linked to categories. In the second and third rounds, physiotherapists had to judge whether each category/personal factor was relevant for describing functioning in schizophrenia.

RESULTS

Thirteen of 22 eligible physiotherapists from eight countries responded to the first round, and 10 completed all three rounds. Eighty-two (84.5%) of the 97 categories in the Comprehensive Core Set for schizophrenia and all 25 categories in the Brief Core Set were considered relevant. A total of five categories were additionally identified.

CONCLUSIONS

The barriers, personal characteristics/resources, and environmental factors from the physiotherapists' perspective have been identified. The results largely confirm the content validity of the Core Sets for schizophrenia.Implications for rehabilitationThis study shows which barriers, personal characteristics/resources, and environmental factors in persons with schizophrenia are relevant from physiotherapists' perspective and should be integrated in the rehabilitation process.The content validity of the Comprehensive and Brief Core Sets for schizophrenia is largely supported from the physiotherapists' perspective and therefore could be used in the assessment of functioning in persons with schizophrenia.The Comprehensive and Brief ICF Core Sets for schizophrenia could be used to plan and assess multidisciplinary rehabilitation interventions.

Sex difference in the association between physical activity and suicide attempts among adolescents from 48 countries: A global perspective

BACKGROUND

Adolescent suicide is a global public health concern. Given that physical activity has a positive effect in the prevention and treatment of common psychiatric disorders, it may also protect against suicides. However, global data examining associations between physical activity and suicide attempts among adolescents are lacking, and sex-specific associations remain poorly understood. Thus, we assessed the association between physical activity and suicide attempts among adolescents aged 12-15 year from 48 countries.

METHODS

Cross-sectional data from the Global School-based Student Health Survey, which included 136,857 adolescents [mean age (SD) 13.8 (1.0) years; 48.9% girls] were analyzed. Suicide attempt was defined as at least one suicide attempt in the past 12 months. Physical activity was assessed by the PACE+ Adolescent Physical Activity Measure and participants were dichotomized into those who do and do not comply with the World Health Organization physical activity recommendations (60 min of moderate-to-vigorous intensity physical activity daily). Multivariable logistic regression analysis and meta-analysis were conducted to assess the associations.

RESULTS

Meeting physical activity guidelines was associated with lower odds for suicide attempts in boys (OR=0.78; 95%CI=0.70-0.86), but higher odds for suicide attempts in girls (OR=1.22; 95%CI=1.10-1.35). The associations for boys and girls were relatively consistent across countries.

LIMITATIONS

Causality or temporal associations cannot be established due to the cross-sectional nature of the study.

CONCLUSIONS

Engagement in physical activity may be an effective strategy for prevention of suicide attempts for boys but not for girls. Future studies should investigate the factors that lead to this sex difference.

Joint association of ultra-processed food and sedentary behavior with anxiety-induced sleep disturbance among Brazilian adolescents

AIMS

We analyzed the joint association of high ultra-processed food ingestion and sedentary behavior (SB) with anxiety-induced sleep disturbance among Brazilian adolescents.

METHODS

Data from the Brazilian Scholar Health Survey, a nationally representative survey of 9th grade adolescents [mean: 14.28 years (range: 11-18 years)] conducted in 2015 (n = 100,648) were used. Self-reported anxiety-induced sleep disturbance, SB (TV viewing and total sitting time), and frequency of ingestion of different ultra-processed foods were collected. Age, ethnicity, type of city (capital or interior), region of the country, and habitual physical activity (global scholar survey questionnaire) were covariates. Logistic regression analyses were conducted to assess the associations.

RESULTS

High ultra-processed food ingestion plus low SB [boys:OR:1.44(99%CI:1.16-1.79), girls:OR:1.41(99%CI:1.22-1.63)] were risk factors for anxiety-induced sleep disturbance. The highest risk of anxiety-induced sleep disturbance was observed among those who joint high ultra-processed food ingestion with high SB [boys:OR:1.85(99%CI:1.46-2.35), girls:OR:1.62(99%CI:1.39-1.89)]. In addition, the interaction of high ultra-processed food ingestion with TV-viewing substantially increased the odds of anxiety-induced sleep disturbance [boys:OR:2.03(99%CI:1.61-2.56), girls:OR:2.04(99%CI:1.76-2.36)].

CONCLUSIONS

Both the high consumption of ultra-processed foods and SB (especially TV-viewing) appear to be independently associated with anxiety-induced sleep disturbance in both sexes. However, the co-occurrence of both negative lifestyle behaviors is associated with a substantial increase in the risk of anxiety-induced sleep disturbance. Future longitudinal research is required to confirm/refute our findings and explore potential mechanisms.

Assessing physical activity in people with mental illness: 23-country reliability and validity of the simple physical activity questionnaire (SIMPAQ)

BACKGROUND

Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. Increases in physical activity are associated with improvements in symptoms of mental illness and reduction in cardiometabolic risk. Reliable and valid clinical tools that assess physical activity would improve evaluation of intervention studies that aim to increase physical activity and reduce sedentary behaviour in people living with mental illness.

METHODS

The five-item Simple Physical Activity Questionnaire (SIMPAQ) was developed by a multidisciplinary, international working group as a clinical tool to assess physical activity and sedentary behaviour in people living with mental illness. Patients with a DSM or ICD mental illness diagnoses were recruited and completed the SIMPAQ on two occasions, one week apart. Participants wore an Actigraph accelerometer and completed brief cognitive and clinical assessments.

RESULTS

Evidence of SIMPAQ validity was assessed against accelerometer-derived measures of physical activity. Data were obtained from 1010 participants. The SIMPAQ had good test-retest reliability. Correlations for moderate-vigorous physical activity was comparable to studies conducted in general population samples. Evidence of validity for the sedentary behaviour item was poor. An alternative method to calculate sedentary behaviour had stronger evidence of validity. This alternative method is recommended for use in future studies employing the SIMPAQ.

CONCLUSIONS

The SIMPAQ is a brief measure of physical activity and sedentary behaviour that can be reliably and validly administered by health professionals.

The Association Between Sedentary Behavior and Sarcopenia Among Adults Aged ≥65 Years in Low- and Middle-Income Countries

The present study aimed to assess the association between sedentary behavior and sarcopenia among adults aged ≥65 years. Cross-sectional data from the Study on Global Ageing and Adult Health were analyzed. Sarcopenia was defined as having low skeletal muscle mass and either a slow gait speed or a weak handgrip strength. Self-reported sedentary behavior was assessed as a continuous variable (hours per day) and also as a categorical variable (0-<4, 4-<8, 8-<11, ≥11 hours/day). Multivariable logistic regression was conducted to assess the association between sedentary behavior and sarcopenia. Analyses using the overall sample and country-wise samples were conducted. A total of 14,585 participants aged ≥65 years were included in the analysis. Their mean age was 72.6 (standard deviation, 11.5) years and 55% were females. Compared to sedentary behavior of 0-<4 hours/day, ≥11hours/day was significantly associated with 2.14 (95% CI = 1.06-4.33) times higher odds for sarcopenia. The country-wise analysis showed that overall, a one-hour increase in sedentary behavior per day was associated with 1.06 (95% CI = 1.04-1.10) times higher odds for sarcopenia, while the level of between-country heterogeneity was low (I2 = 12.9%). Public health and healthcare practitioners may wish to target reductions in sedentary behavior to aid in the prevention of sarcopenia in older adults.

Is there an association between cardiorespiratory fitness and stage of illness in psychotic disorders? A systematic review and meta-analysis

BACKGROUND

Clinical staging models describe where an individual exists on a continuum from asymptomatic at-risk states (Stage 0) through to established late-stage disease (Stage 4). We applied this framework to systematically assess evidence for any associations between objectively assessed cardiorespiratory fitness (CRF) and stage of psychosis.

METHOD

Nine electronic databases were searched for relevant publications from inception until October 31, 2019. Pooled effect sizes (Hedges' g and 95% confidence intervals (95% CI)) were estimated for differences in CRF for studies that reported mean oxygen uptake (max, peak, or predicted VO₂ in ml/kg/min).

RESULTS

Thirty-eight studies were eligible. Findings indicated that suboptimal CRF can be present at Stages 0 and 1. Meta-analyses of 22 studies demonstrated that CRF was significantly reduced in individuals classified between Stages 1 and 4 compared with matched or general population controls (g = -0.93; 95% CI -1.14, -0.71). Mean VO₂ was decreased by 28% in Stage 4 compared with Stage 1 (34.1 vs. 24.66 ml/kg/min); the largest effect size for CRF reduction was reported between Stages 2 and 3 (g = -1.16; 95% CI -1.31, -1.03).

CONCLUSIONS

Although not identifying direct causal links between clinical stage and CRF, using this framework may enhance understanding of co-associations between mental and physical health markers across the entire spectrum of psychosis. Limitations include lack of research on CRF in Stages 0 and 1 alongside problems determining stage in some studies. However, impaired CRF is reported in emerging psychosis, supporting calls that early intervention programmes should address both mental and physical wellbeing.

Informal caregiving and physical activity among 204,315 adults in 38 low- and middle-income countries: A cross-sectional study

Data on the association between informal caregiving and physical activity (PA) levels are scarce, especially from low- and middle-income countries (LMICs). Furthermore, previous research has yielded conflicting results. Thus, we investigated this association in adults from 38 LMICs. Data from the World Health Survey (WHS), a cross-sectional, predominantly nationally representative survey conducted in 2002-2004, were analyzed. PA was assessed by the International Physical Activity Questionnaire and participants were dichotomized into those who do (≥150 min of moderate-to-vigorous PA per week) and do not (<150 min = low PA) comply with the World Health Organization PA recommendations. Those who provided help to a relative or friend (adult or child), because this person has a long-term physical or mental illness or disability, or is getting old and weak in the past year were considered to be informal caregivers. Multivariable logistic regression analysis was conducted to assess the associations. There were 204,315 adults aged ≥18 years from 38 LMICs included in this study [mean (standard deviation) age 38.6 (16.1) years; 50.7% female]. Overall, the prevalence of caregiving and low PA was 19.5% and 29.9%, respectively. After adjustment for potential confounders, caregivers were at a lower risk for low PA compared to non-caregivers (OR = 0.79; 95% CI = 0.72-0.86). Engagement in greater number of caregiving activities was associated with lower odds for low PA dose-dependently. Informal caregiving was associated with higher levels of PA in adults in LMICs. Future studies of longitudinal design are warranted to understand causality and the underlying mechanisms of this association.

Associations of sedentary behavior in leisure and occupational contexts with symptoms of depression and anxiety

Sedentary behaviors (SB) can be associated with poorer mental health, but it remains unclear whether contexts for these behaviors may be important. We assessed relationships of SB in leisure-time and occupational contexts with frequent symptoms of depression and anxiety. Data originate from the Swedish Health Profile Assessment (HPA) database, a health assessment offered to employees working for companies or organizations connected to healthcare services. Analyses are based on data from 2017 onwards (N = 23,644; 57% male, mean age = 42 years). Two self-report questions assessed proportions of time spent in SB in leisure contexts and in the occupational setting. Logistic regressions examined relationships of SB in each context with the self-reporting of frequent symptoms of depression/anxiety. A separate model for the leisure plus occupational SB was also generated. Fully-adjusted models included exercise frequency. Compared to those reporting that they were 'almost never' sedentary in leisure-time contexts, a detrimental dose-response with frequent depression/anxiety symptoms was observed with increasing proportions of sedentary time: 50% of the time (OR = 1.44; 1.23-1.70), 75% (OR = 2.95; 2.45-3.54), almost always (OR = 3.85; 2.84-5.22). For occupational SB, the only associations were among those who reported being sedentary almost always, compared to almost never (OR = 1.47; 1.25-1.73). Associations of 'overall' SB with depression/anxiety symptoms mirrored the dose-response relationship for leisure-time SB. Exercise frequency attenuated the association for leisure-time SB only, but it remained statistically significant. Adults who spend ≥50% of their leisure-time in sedentary pursuits experience more frequent symptoms of depression and anxiety, compared to those who are less sedentary in that context.

Does physical activity reduce the risk of psychosis? A systematic review and meta-analysis of prospective studies

Longitudinal prospective cohorts have suggested that physical activity (PA) may be a protective factor against psychosis and schizophrenia. However, no meta-analysis has been conducted. The study aims to examine the prospective relationship between PA and incident psychosis/schizophrenia. Major databases were searched from inception to July 2019 for prospective studies that calculated the odds ratio (OR) or the adjusted odds ratio (AOR) of incident psychosis/schizophrenia in people with higher PA against people with lower PA. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was conducted, for OR and AOR, separately. Across 4 cohorts (N = 30,025 median males = 50%, median follow-up = 32 years), people with high self-reported PA (versus low PA) were at reduced odds of developing psychosis/schizophrenia (OR = 0.73, 95%CI 0.532 to 0.995, p = 0.047). Analysis including 2 cohorts presenting AOR were not statistically significant (AOR = 0.59, 95%CI 0.253 to 1.383, p = 0.226). Overall study quality was high (mean NOS = 7.0). The literature on the topic is scarce, whilst crude analysis suggests that PA may be a protective factor against the emergence of psychosis/schizophrenia, but when adjusting for covariates, the association is no longer significant. Further studies with objective physical activity and adjustment for confounders are needed.

Sedentary behavior and depression among community-dwelling adults aged ≥50 years: Results from the irish longitudinal study on Ageing

BACKGROUND

Sedentary behavior (SB) may be a risk factor for depression in middle- and old age adults. The aim of this study was to examine cross-sectional and longitudinal relationships between SB and depression in a large national sample of Irish people aged 50 and older taking into account a wide range of previously identified influential factors.

METHODS

Data from the Irish Longitudinal Study on Ageing survey were analyzed (wave 1: 2009-2011, wave 2: 2012-2013). Depression was assessed with the Center for Epidemiologic Studies Depression scale. Total weekday SB and control variables were self-reported. Multivariable logistic regression and mediation analysis were conducted to assess the associations.

RESULTS

The final sample consisted of 6903 individuals aged ≥50 years (63.6 ± 9.2years; 52.1% female). After full adjustment for age, gender, social class, current smoking, physical activity, mobility, pain, cognition, chronic physical conditions, disability, anxiety, loneliness, and social network, the association between SB and depression was not statistically significant (OR=1.06; 95%CI=0.60-1.89). Mediation analysis showed that the association is explained by social network (mediated percentage 23.1%), physical activity (20.3%), loneliness (13.2%), chronic physical conditions (11.1%), and disability (7.9%). Cross-sectional analysis showed that SB is significantly associated with depression even after full adjustment.

LIMITATIONS

SB was self-reported.

CONCLUSIONS

Factors closely linked with SB such as social isolation, loneliness, physical inactivity, chronic physical conditions, and disability may play a major role in depression among middle-aged and older people. Lifestyle interventions focusing on reductions in depression in this population need to consider these factors.

[The efficacy of physical activity on psychiatric symptoms and physical health in people with psychiatric disorders: a systematic review of recent meta-analyses]

Physical activity (PA) has been introduced in the sixties as standard care in the mental health care systems of The Netherlands and Belgium.<br/> AIM: To summarize the recent meta-analytic evidence of PA in the prevention and treatment of depressive disorders, anxiety disorders, psychotic disorders, bipolar disorders, substance use disorders, adhd, autism, and eating disorders.<br/> METHOD: medline/PubMed, Psycarticles and Embase were searched from January 1st, 2015 until January 31st, 2020 for meta-analyses of randomized controlled trials and cohort studies.<br/> RESULTS: There is strong evidence for the beneficial effects of PA in the treatment of mild and moderate depression in children / adolescents and adults, severe depression, anxiety disorders and psychotic disorders in adults and reductions in adhd-symptoms in children. PA reduces the risk for depression, anxiety and to a lesser extent also psychosis. PA also improves cardiorespiratory fitness and quality of sleep in people with a psychiatric disorder.<br/> CONCLUSION: There is trans-diagnostic scientific evidence for the beneficial effects of PA on psychiatric symptoms and physical health in people with a psychiatric disorder.

Association of bullying victimization with overweight and obesity among adolescents from 41 low- and middle-income countries

BACKGROUND

Data on the association between overweight/obesity and bullying victimization among adolescents are scarce from low- and middle-income countries.

OBJECTIVES

We assessed the associations between overweight/obesity and bullying victimization in 41 low- and middle-income countries.

METHODS

Cross-sectional data from the Global School-based Student Health Survey were analysed. Data on past 30-day bullying victimization (including type) and body mass index based on measured weight and height were collected. The 2007 WHO Child Growth reference was used to define overweight and obesity. Multivariable logistic regression (multinomial and binary) and meta-analyses based on country-wise estimates were conducted. Data on 114 240 adolescents aged 12 to 15 years were analysed (mean age [SD], 13.8 [1.0] y; 48.8% girls).

RESULTS

Among girls, compared with normal weight, overweight (OR = 1.08; 95% CI, 1.02-1.16; between-country heterogeneity I²  = 0.0%) and obesity (OR = 1.20; 95% CI, 1.07-1.34; I²  = 0.0%) were associated with significantly higher odds for any bullying victimization, but no significant association was observed among boys. However, overweight and obesity were both associated with significantly increased odds for bullying by being made fun of because of physical appearance among both sexes-obesity (vs normal weight): girls OR = 3.42 (95% CI, 2.49-4.71); boys OR = 2.38 (95% CI, 1.67-3.37).

CONCLUSIONS

Effective strategies to reduce bullying of children with overweight/obesity are needed in low- and middle-income countries.

Lifestyle behaviors among 4,343 Brazilian adults with severe mental illness and 55,859 general population controls: data from the Brazilian National Health Survey

Objective:

To analyze the association between severe mental illnesses and health behaviors among Brazilian adults.

Methods:

We used data from the Brazilian National Health Survey, a large nationally representative cross-sectional study conducted in 2013 among 60,202 adults (≥ 18 years). Clinical diagnoses (major depressive disorder, bipolar disorder and schizophrenia), lifestyle behaviors (leisure-time physical activity, TV viewing, tobacco use and the consumption of alcohol, sweets, and soft drinks) and potential confounders (chronological age, race, educational and employment status) were self-reported. Logistic regression models were used to examine the associations between severe mental illness and lifestyle behaviors, adjusting for confounders.

Results:

Schizophrenia (n=41) was associated with lower odds of physical activity (OR 0.08 [95%CI 0.01-0.58]). Major depressive disorder (n=4,014) was associated with higher odds of TV viewing (OR 1.34 [95%CI 1.12-1.61]), tobacco use (OR 1.37 (95%CI 1.18-1.58]), consumption of sweets (OR 1.34 (95%CI 1.15-1.55]) and consumption of soft drinks (OR 1.24 (95%CI 1.06-1.45]). There were no significant associations between bipolar disorder (n=47) and any lifestyle behaviors.

Conclusions:

Schizophrenia was associated with lower physical activity, while major depressive disorder was associated with increased TV viewing, tobacco use, and consumption of sweets and soft drinks. These findings reinforce the need for prevention and treatment interventions that focus on people with severe mental illness in Brazil.

Functional exercise capacity is associated with global functioning in patients with alcohol use disorder

This study explored whether the Global Assessment of Functioning (GAF) score is associated with the functional exercise capacity among inpatients with alcohol use disorders (AUD). 45 (32 men) inpatients (41.1 ± 13.2 years, range = 18-70 years) performed a 6-minute walk test (6 MWT), a standing broad jump (muscle strength) and were assessed with several questionnaires. The GAF-score correlated significantly with the 6 MWT-score (Pearson's r = 0.47, p = 0.002). Variance in illness duration (11.1 ± 11.0 years) explained 27.9% of the GAF-score (50.8 ± 8.0) variance. Variance in GAF and muscle strength (148.3 ± 44.8 cm) explained 50.9% of the 6 MWT-score (638.2 ± 77.6 m) variance. Future research should explore whether improving the functional exercise capacity improves global functioning in this vulnerable population.

Test-retest reliability, validity, and correlates of the 2-min walk test in outpatients with depression

OBJECTIVES

A reason for the lack of interest in physical fitness testing in mental healthcare is limited time among existing staff. This cross-sectional study investigated the test-retest reliability of the 2-min walk test (2MWT) and its concurrent validity with the 6-min walk test (6MWT) in Ugandan patients with depression. We also explored practice effects and assessed the minimal detectable change (MDC) and clinical correlates with the 2MWT.

METHODS

This is a cross-sectional study executed in Butabika National Referral Hospital in Kampala, Uganda. Fifty Ugandan patients with depression (15 women; median age = 29.0 years) performed twice a 2MWT, once a 6MWT, and completed the Simple Physical Activity Questionnaire (SIMPAQ), and Brief Symptoms Inventory-18 (BSI-18).

RESULTS

The median (interquartile) 2MWT score on the first and second test were 125.5 (59.2) meters and 131.0 (57.0) meters (p = .28). The intraclass correlation was.96 (95% confidence interval [0.94, 0.98]). The MDC was 23.5 m for men and 23.4 m for women. There was no evidence of a practice effect. Scores on BSI-18 depression, SIMPAQ walking, and SIMPAQ incidental physical activity explained 66.3% of 2MWT score variance.

CONCLUSION

The 2MWT is a reliable test, which can be conducted without any special equipment or substantial time demands, to provide a valid assessment of the functional exercise capacity in outpatients with depression.

Cannabis use and leisure-time sedentary behavior among 94,035 adolescents aged 12-15 years from 24 low- and middle-income countries

Adolescents spend a high proportion of their leisure time in sedentary behavior, which is associated with adverse physical and mental health outcomes. Exploring factors associated with leisure-time sedentary behavior (LTSB) is important for the development of targeted interventions. The aim of this study was to explore associations between cannabis use and LTSB in adolescents from 24 low- and middle-income countries. Data from the Global School-based Student Health Survey were analyzed. Data on past month cannabis use and LTSB during a typical day were collected. Multivariable logistic regressions were conducted to assess the associations. Among 94,035 adolescents aged 12-15 years [age = 13.7 ± SD 0.9 years; 49.2% female], the prevalence of high LTSB (≥3 h/day) was 26.6%, while 2.8% used cannabis at least once in the past 30 days. In adjusted analyses, compared to those who did not consume cannabis in the past 30 days, the OR (99%CI) for high LTSB among those who used cannabis 1-2 times, 3-9 times, 10-19 times, and ≥20 times were 0.89 (0.58-1.35), 1.96 (1.26-3.07), 1.97 (0.71-5.47), and 2.34 (0.95-5.78), respectively (test for trend p < 0.01). Our data suggest that frequent cannabis use is associated with increased odds for being more sedentary in adolescence. Future longitudinal data are required to confirm/refute the findings to inform public health campaigns.

Test-retest reliability, concurrent validity and correlates of the two-minute walk test in outpatients with psychosis

The aim of this study was to investigate the test-retest reliability of the 2-minute walk test (2MWT) and the concurrent validity with the 6-minute walk test (6MWT) in outpatients with psychosis. We also explored whether there was a practice effect, determined minimal detectable changes (MDC) and assessed which factors are associated with the 2MWT performance. Fifty outpatients [22 women; 33.5 (14.3) years] performed the 2MWT twice and the 6MWT once and completed the Simple Physical Activity Questionnaire (SIMPAQ) and Brief Symptoms Inventory -18. The median (interquartile) 2MWT score on the first and second test were 128.0 (44.0) meters and 128.0 (31.5) meters, without significant difference between the two trials. The intraclass coefficient was 0.94 (95% confidence interval=0.91-0.97). The significant Spearman Rho correlation between the second 2MWT and the 6MWT was 0.69. The MDC was 22 m for men and 21 m for women. There was no evidence for a practice effect. Variability in SIMPAQ sedentary, exercise, incidental physical activity and leg pain following the test explained 54.6% of the variance in 2MWT score. The current study demonstrates that the 2MWT is a reliable, valid and clinically feasible tool for assessing and evaluating the functional exercise capacity in outpatients with psychosis.

Cannabis use and physical activity among 89,777 adolescents aged 12-15 years from 21 low- and middle-income countries

BACKGROUND

Cannabis legalization and use are increasing globally, however, little is known about associations between cannabis use and other health behaviors, such as physical activity (PA). Importantly, the extent to which cannabis use is associated with PA in adolescents is yet to be explored in low- and middle-income countries (LMICs), where there may be unique sociodemographic and environmental characteristics compared with high-income countries. Therefore, this study examined the association between PA and cannabis use among adolescents in 21 LMICs using data from the 2010-2016 Global School-based Student Health Survey.

METHODS

A multivariable logistic regression analysis was performed among a final sample of 89,777 adolescents (49.2% females) aged 12-15 years with a mean (SD) age of 13.7 (0.9) years.

RESULTS

The overall prevalence of past (i.e., in lifetime but not in past 30 days) and current (in past 30 days) cannabis use were 1.0% and 2.9% respectively, while the prevalence of adequate PA in the past week (7 days/week of 60 min of PA) was 16.6%. The prevalence of adequate levels of PA in past and current cannabis use was 7.3% and 6.9%, respectively. Current and past cannabis use (vs. never) were associated with a significant 0.62 (95% CI = 0.41-0.94) and 0.43 (95%CI = 0.30-0.63) times lower odds for achieving adequate levels of PA, respectively.

CONCLUSION

The results underscore the high prevalence of low PA among adolescents in LMICs, and emphasize the need to understand behavioral factors that may affect PA levels, such as cannabis use, when designing interventions to improve health.