The Role of Exercise in Preventing and Treating Depression

Identifying high-risk population of depression: association between metabolic syndrome and depression using a health checkup and claims database

Depression and metabolic syndrome (MetS) are correlated, leading to an increased healthcare burden and decreased productivity. We aimed to investigate the association between MetS-related factors and depression using a health checkup and claims database. Individuals aged 18-75 years who underwent health examinations between 2014 and 2019 were enrolled in the study. Among 76,277 participants, "ever" and "incident" antidepressant users exhibited worse metabolic profiles and were more likely to be prescribed hypnotics and anxiolytics than "never" users. In a nested case-control study with a 1:10 ratio of incident users to controls, MetS was associated with incident antidepressant use (odds ratio, 1.53 [95% confidence interval 1.24-1.88]) adjusted for lifestyle information obtained from a self-administered questionnaire, medical history, and medications. Other metabolic traits also showed significant associations: body mass index (1.04 [1.02-1.06]), abdominal circumference per 10 cm (1.17 [1.08-1.27]), high blood pressure (1.17 [1.00-1.37]), glucose intolerance (1.29 [1.05-1.58]), and dyslipidemia (1.27 [1.08-1.51]). A bodyweight increase > 10 kg from age 20 years (1.46 [1.25-1.70]) was also significantly associated with incident antidepressant use. In conclusion, metabolic abnormalities were associated with incident antidepressant use and can be useful in identifying populations at high risk of depression.

The Effects of Tai Chi on the Executive Functions and Physical Fitness in Middle-Aged Adults with Depression: A Randomized Controlled Trial

Objective

The present study examined the effects of Tai Chi exercise on the executive functions (EFs) and physical fitness of middle-aged adults with depression.

Methods

A total of 39 middle-aged adults with depression (M_age = 50.59, SD = 7.38) were randomly assigned to the Tai Chi group (n = 20) or the waiting-list control group (n = 19). The Tai Chi group engaged in two 90 min sessions of Tai Chi exercise per week for 12 weeks; the waiting-list control group was asked to maintain their usual daily routines for 12 weeks. Depression symptoms, EFs (i.e., inhibitory control, planning, working memory, and cognitive flexibility), and physical fitness (i.e., cardiovascular fitness, muscular strength, muscular endurance, power, and flexibility) were evaluated at the baseline (pretest), 6-week (mid-test), and 12-week (post-test) marks.

Results

Both groups showed decreased depression symptoms over time. Compared with the control group, the Tai Chi group showed decreased reaction times for incongruent conditions in the Stroop test from pretest to mid- and post-test, and shorter reaction time for incongruent conditions in the Stroop test than the control group at post-test; the Tai Chi group performed significantly better than the control group in overall total move score of Tower of London (TOL). The Tai Chi group also showed increased total correct scores of TOL from pretest to mid- and post-test, and greater total correct scores of TOL than the control group at post-test. Additionally, results indicated that Tai Chi exercise comprehensively improved physical fitness from pretest to mid- and post-test. Greater performance in terms of cardiovascular fitness, muscular strength, and power was also found in the Tai Chi group at post-test than in the control group.

Conclusions

These findings suggest that the 12-week Tai Chi exercise improved inhibitory control, planning and working memory aspects of executive functions, and physical fitness in middle-aged adults with depression.

Motivation to train during a pandemic: The role of fitness resources, mental health, and motivational profiles among student-athletes in team sports

The sporting season across post-secondary institutions was canceled in March 2020 due to COVID-19, and student-athletes had to maintain their training at home. It is unclear what personal and contextual factors facilitated student-athletes' ability to maintain their training routines at home when social distancing and lockdown (SD/L) policies were put in place. Our cross-sectional study of 433 student-athletes examined (a) how athletes adapted their training, (b) what training barriers they experienced, (c) whether motivational profiles were associated with differences in training behaviors and mental health, and (d) what variables predicted athletes' motivation to train during this prolonged offseason. Student-athletes across Canada were recruited to complete an online survey between August and September 2020. Results showed that athletes significantly reduced their training load and intensity, with approximately 25% exercising two or fewer days a week. Barriers to training included limited access to fitness resources and equipment, having inconsistent training schedules, and experiencing emotional distractions, with some of these barriers more common among female athletes than male athletes. For motivation profiles, athletes with higher levels of intrinsic motivation tended to maintain the intensity of their workouts and experienced lower mood disturbance. A hierarchical multiple regression revealed that being male, being younger, having higher levels of intrinsic and introjected motivation, having access to fitness resources, maintaining a steady training schedule, having fewer emotional distractions, and lower mood disturbance were significant predictors to being motivated to train during the pandemic. We discuss strategies coaches and trainers can implement to best support their student-athletes.

Physical exercise prevents behavioral alterations in a reserpine-treated zebrafish: A putative depression model

Major depressive disorder (MDD) has increasingly reached the world population with an expressive increase in recent years due to the COVID-19 pandemic. Here we used adult zebrafish (Danio rerio) as a model to verify the effects of reserpine on behavior and neurotransmitter levels. We observed an increase in the immobile time and time spent in the bottom zone of the tank in reserpine-exposed animals. The results demonstrated a decrease in distance traveled and velocity. Reserpine exposure did not induce changes in memory and social interaction compared to the control group. We also evaluated the influence of exposure to fluoxetine, a well-known antidepressant, on the behavior of reserpine-exposed animals. We observed a reversal of behavioral alterations caused by reserpine. To verify whether behavioral alterations in the putative depression model induced by reserpine could be prevented, the animals were subjected to physical exercise for 6 weeks. The results showed a protective effect of the physical exercise against the behavioral changes caused by reserpine in zebrafish. In addition, we observed a reduction in dopamine and serotonin levels and an increase in the 3,4-dihydroxyphenylacetic acid (DOPAC) levels in the brain. Physical exercise was able to prevent the changes in dopamine and serotonin levels, reinforcing that the preventive effect promoted by physical exercise is related to the modulation of neurotransmitter levels. Our findings showed that reserpine was effective in the induction of a putative depression model in zebrafish and that physical exercise may be an alternative to prevent the effects induced by reserpine.

A multi-perspective qualitative exploration of the reasons for changes in the physical activity among 10-11-year-old children following the easing of the COVID-19 lockdown in the UK in 2021

Background

Active-6 is exploring how the COVID-19 pandemic has impacted physical activity behaviour among Year 6 children (aged 10–11 years) and their parents in Southwest England. Initial findings from the Active-6 project have shown a 7–8 min decrease in moderate-to-vigorous physical activity and an increase in sedentary behaviour among children following the easing of restrictions in the UK in latter half of 2021. This finding suggests that the pandemic has had a persistent impact on child physical activity behaviour. This paper explored the possible mechanisms behind these changes.

Methods

Interviews with parents (n = 21), members of school staff (n = 9) and focus groups with children aged 10–11 years (n = 47) were conducted between August and December 2021 to discuss the impact of the pandemic on child physical activity behaviour. The framework method was used for analysis.

Results

Five themes spanning two key stages of the pandemic were described. Three themes related to the period of lockdowns and fluctuating restrictions (March 2020 – April 2021). These included: Theme 1) Lockdown: A short-lived adventure; Theme 2) Access to facilities during restrictions; and Theme 3) The importance of the parent. A further two themes were identified related to the period following the gradual easing of restrictions in April 2021. These included: Theme 4) An overwhelming return to normal; and Theme 5) Reopening fatigue.

Conclusions

The analysis suggested that feelings of novelty experienced during the initial stages of lockdown waned as restrictions were prolonged, creating an increasingly challenging period for parents and their children. However, during periods of restrictions, the importance of parental encouragement and access to appropriate facilities in the local and home environment helped facilitate physical activity. Following the easing of COVID-19 restrictions, emotional overwhelm and physical fatigue among children, stemming from a sedentary and socially isolated life in lockdown and other restrictions, were key contributors to the decreased moderate to vigorous physical activity and increased sedentary behaviour that was observed in a related quantitative study.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01356-3.

Longer term benefits of exercise and escitalopram in the treatment of anxiety in patients with coronary heart disease: Six month follow-up of the UNWIND randomized clinical trial

BACKGROUND

Anxiety is a common comorbidity in patients with coronary heart disease (CHD) and is associated with worse prognosis. However, effective treatment for anxiety in CHD patients is uncertain. The UNWIND randomized clinical trial showed that 12-week treatment of escitalopram was better than exercise training or placebo in reducing anxiety in anxious CHD patients. The longer-term benefits of treatment for anxiety are not known.

METHODS

Patients were randomized to 12 weeks of Escitalopram (up to 20 mg), Exercise (3 times/wk), or placebo pill. At the conclusion of treatment, participants were followed for 6-months to determine the persistence of benefit on the primary anxiety endpoint assessed by the Hospital Anxiety and Depression Scale-Anxiety scale (HADS-A) and to assess the effects of treatment on major adverse cardiac events over a follow-up period of up to 6 years.

RESULTS

Of the 128 participants initially randomized, 120 (94%) were available for follow-up. Participants randomized to the Escitalopram condition exhibited lower HADS-A scores (3.9 [3.1, 4.7]) compared to those randomized to Exercise (5.5 [4.6, 6.3]) (P = .007) and Placebo (5.3 [4.1, 6.5]) (P = .053). Over a median follow-up of 3.2 years (IQR: 2.3, 4.5), there were 29 adverse events but no significant between-group differences.

CONCLUSION

In the UNWIND trial, 12 weeks of escitalopram treatment was effective in reducing anxiety. These beneficial effects were sustained for 6 months posttreatment. Although moderate or vigorous physical activity has a number of health benefits, exercise was not an effective treatment for anxiety in patients with CHD.

The association between social engagement and depressive symptoms in middle-aged and elderly Chinese: A longitudinal subgroup identification analysis under causal inference frame

Background

Studies have suggested that there is a significant association between social engagement and depression symptoms. However, this association may differ in people with different features such as different sociodemographic characteristics and health conditions.

Methods

Research data were obtained from the CHARLS database. The causal inference was performed with the propensity score. We used the linear mixed-effects model tree algorithm under the causal inference frame for subgroup identification analysis.

Results

We included 13,521 participants, and the median follow-up time is 4 years. Under the casual inference frame, the association between social engagement and depression symptoms is confirmed for all included individuals (OR = 0.957, P = 0.016; 95%CI: 0.923–0.992). Using the linear mixed-effects model tree, we found two subgroups, including middle-aged and elderly residents who live in rural areas with <6 h of sleep and those living in urban areas, could benefit more from social engagement. After using the propensity score method, all the two subgroups selected are statistically significant (P = 0.007; P = 0.013) and have a larger effect size (OR = 0.897, 95%CI: 0.830–0.971; OR = 0.916, 95%CI: 0.854–0.981) than the whole participants. As for sex difference, this associations are statistically significant in male (OR: 0.935, P = 0.011, 95%CI: 0.888–0.985) but not in female (OR: 0.979, P = 0.399, 95%CI: 0.931–1.029).

Conclusions

Our findings indicate that social engagement may reduce the risks of depressive symptoms among all individuals. The identified subgroups of middle-aged and elderly residents who live in rural areas with <6 h of sleep and those who live in urban areas may benefit more from the social engagement than the whole participants.

Leisure-Time Activities in Different Contexts and Depressive Symptoms in Norwegian Adolescents: A Cross-Sectional Study

The purpose of this study was to examine the association between physical activity organised in sports clubs, non-organised physical activity, other organised leisure-time activities, and depressive symptoms among adolescents. This study was based on cross-sectional data from the Ungdata survey conducted between 2017 and 2019. The sample comprised 7656 adolescents (aged 13-16 years). Binominal logistic regression was used to analyse the association between the three different leisure-time activities and depressive symptoms. All models were adjusted for gender, family economy, parents' higher education, having friends, alcohol intoxication, and smoking. The odds for symptoms of depression were higher for those who were less physically active in a sports club (OR: 1.34, 95% CI: 1.15-1.57) and in non-organised physical activities (OR: 1.50, 95% CI: 1.29-1.74) and lower for those who participated less in other organised leisure-time activities (OR: 0.79, 95% CI: 0.68-0.92) compared with those who were physically active (sports club and non-organised) and those who participated in other organised leisure-time activities. Our findings suggested that being physically active, both in a sports club and in non-organised activities, was associated with lower odds of depressive symptoms among adolescents. Additional research is needed to confirm a possible causal relationship.

Exercise as a Potential Therapeutic Strategy to Target the Clinical Link Between Depression and Alzheimer's Disease: A Narrative Review

Alzheimer's disease (AD) and major depressive disorder (MDD) affect millions worldwide and both cause significant morbidity and mortality. While clinically distinctive, patients with MDD can present with memory dysfunction and patients with AD commonly report symptoms of depression. Additionally, brain pathology in MDD and AD both demonstrate decreased hippocampal volumes, and severe disease is associated with smaller hippocampal volumes in both disorders. Hippocampal neurogenesis occurs daily in healthy individuals, an impaired process in AD and MDD. MDD is thus suggested to be a risk factor for developing AD later in life; moreover, depression onset alongside AD indicates a worse prognosis. Treatment options that target hippocampal neurogenesis are being evaluated for both diseases, and aerobic exercise has shown promising results. We searched PubMed for relevant review articles published since 2000 encompassing the topics of hippocampal neurogenesis and exercise in relation to depression and AD, including novel clinical trials if they contributed information not in the chosen reviews. While much data indicates that exercise increases hippocampal neurogenesis in both MDD and AD, mood improvement in MDD, mild quality of life and cognitive improvement in AD, and reduced risk of those with MDD developing AD in response to various exercise regimens, this result was not universal. Some data indicated no difference between exercise groups and controls. Further randomized control trials into exercise as an intervention in treating MDD and preventing AD is required. However, exercise is a low-risk, affordable treatment option and is a feasible additive therapy in patients with AD and MDD.

Muscle strength and incidence of depression and anxiety: findings from the UK Biobank prospective cohort study

BACKGROUND

Depression and anxiety are the leading mental health problems worldwide; depression is ranked as the leading cause of global disability with anxiety disorders ranked sixth. Preventive strategies based on the identification of modifiable factors merit exploration. The aim of the present study was to investigate the associations of handgrip strength (HGS) with incident depression and anxiety and to explore how these associations differ by socio-demographic, lifestyle, and health-related factors.

METHODS

The analytic sample comprised 162 167 participants (55% women), aged 38-70 years, from the UK Biobank prospective cohort study. HGS was assessed at baseline using dynamometry. Depression and anxiety were extracted from primary care and hospital admission records. Cox proportional models were applied, with a 2 year landmark analysis, to investigate the associations between HGS and incident depression and anxiety.

RESULTS

Of the 162 167 participants included, 5462 (3.4%) developed depression and 6614 (4.1%) anxiety, over a median follow-up period of 10.0 years (inter-quartile range: 9.3-10.8) for depression and 9.9 (inter-quartile range: 9.0-10.8) for anxiety. In the fully adjusted model, a 5 kg lower HGS was associated with a 7% (HR: 1.07 [95% CI: 1.05, 1.10]; P < 0.001) and 8% (HR: 1.08 [95% CI: 1.06, 1.10]; P < 0.001) higher risk of depression and anxiety, respectively. Compared with participants in the sex and age-specific highest tertiles of HGS, those in the medium and lowest tertiles had an 11% (HR: 1.11 [95% CI: 1.04, 1.19]; P = 0.002) and 24% (HR: 1.24 [95% CI: 1.16, 1.33]; P < 0.001) higher risk of depression and 13% (HR: 1.13 [95% CI: 1.06, 1.20]; P < 0.001) and 27% (HR: 1.27 [95% CI: 1.19, 1.35]; P < 0.001) higher risk of anxiety, respectively. The association of HGS with depression was stronger among participants with average or brisk walking pace (vs. slow walking pace; P_interaction  < 0.001). The association with anxiety was stronger in those participants aged ≥58 years (vs. ≤58 years; P_interaction  = 0.002) and those living in more affluent areas (vs. deprived; P_interaction  = 0.001).

CONCLUSIONS

Handgrip strength was inversely associated with incident depression and anxiety. Because HGS is a simple, non-invasive, and inexpensive measure, it could be easily used in clinical practice to stratify patients and identify those at elevated risk of mental health problems. However, future research should assess if resistance training aimed at increasing HGS can prevent the occurrence of mental health conditions.

EFFECT OF PHYSICAL EXERCISE ON MEDICAL REHABILITATION TREATMENT OF DEPRESSION

ABSTRACT Introduction: Depression is a common disease worldwide. The main treatment methods currently include medication, psychotherapy, and physical therapy. However, due to limitations in treatment methods, treatment compliance is poor. Participating in various sports is very effective in treating depression. Objective: To verify the influence of sports on the condition of depression and on the effect of its clinical treatment. Methods: The article selected a total of 60 hospitalized patients with depression who were randomly divided into two groups: an experimental group and a control group. The control group took antidepressant drugs for eight weeks, and the experimental group took the drugs with the supplementary practice of sports. The two groups of patients were tested for serum β-endorphin (β-EP) levels before and after treatment, and HAMD scores were performed. Results: The scores and serum β-endorphin (β-EP) levels of the two groups of patients were different, showing that effect of the treatment was better in the experimental group. Conclusion: Physical exercise therapy can mobilize the enthusiasm of patients with depression. This treatment plan increases treatment efficiency and is suitable for long-term clinical promotion and application. Level of evidence II; Therapeutic studies - investigation of treatment results.

Effects of a 6-Month Aerobic Exercise Intervention on Mood and Amygdala Functional Plasticity in Young Untrained Subjects

Acute exercise has beneficial effects on mood and is known to induce modulations in functional connectivity (FC) within the emotional network. However, the long-term effects of exercise on affective brain circuits remain largely unknown. Here, we investigated the effects of 6 months of regular exercise on mood, amygdala structure, and functional connectivity. This study comprised N = 18 healthy sedentary subjects assigned to an intervention group (IG; 23.9 ± 3.9 years; 3 trainings/week) and N = 10 subjects assigned to a passive control group (CG; 23.7 ± 4.2 years). At baseline and every two months, performance diagnostics, mood questionnaires, and structural and resting-state-fMRI were conducted. Amygdala-nuclei segmentation and amygdala-to-whole-brain FC analysis were performed. Linear mixed effects models and correlation analyses were conducted between FC, relVO_2max, and mood scores. Data showed increases in relVO_2max exclusively in the IG. Stronger anticorrelation in amygdala-precuneus FC was found, along with a stronger positive correlation in the amygdala-temporal pole FC in the IG after 4 and 6 months, while mood and amygdala volume did not reveal significant interactions. The relVO_2max/amygdala-temporal pole FC correlated positively, and the amygdala-precuneus/amygdala-temporal pole FC correlated negatively. Findings suggest that exercise induced long-term modulations of the amygdala FC with the precuneus and temporal pole, shedding light on potential mechanisms by which exercise has positive influences on mood-related networks, typically altered in affective disorders.

Accelerometer-measured physical activity and sedentary time among children and their parents in the UK before and after COVID-19 lockdowns: a natural experiment

BACKGROUND

Restrictions due to the coronavirus disease 2019 (COVID-19) pandemic reduced physical activity provision for both children and their parents. Recent studies have reported decreases in physical activity levels during lockdown restrictions, but these were largely reliant on self-report methods, with data collected via unrepresentative self-report surveys. The post-pandemic impacts on children's activity levels remain unknown. A key question is how active children become once lockdown restrictions are lifted.

METHODS

Active-6 is a repeated cross-sectional natural experiment. Accelerometer data from 1296 children aged 10-11 and their parents were collected in 50 schools in the Greater Bristol area, UK in March 2017-May 2018 (pre-COVID-19 comparator group), and compared to 393 children aged 10-11 and parents in 23 of the same schools, collected in May-December 2021. Mean minutes of accelerometer-measured moderate-to-vigorous physical activity (MVPA) were derived for weekdays and weekend and compared pre- and post-lockdown via linear multilevel models.

RESULTS

After adjusting for seasonality, accelerometer wear time and child/parent demographics, children's mean weekday and weekend MVPA were 7.7 min (95% CI: 3.5 to 11.9) and 6.9 min (95% CI: 0.9 to 12.9) lower in 2021 than in 2018, respectively, while sedentary time was higher by 25.4 min (95% CI: 15.8 to 35.0) and 14.0 min (95% CI: 1.5 to 26.5). There was no evidence that differences varied by child gender or household education. There was no significant difference in parents' MVPA or sedentary time, either on weekdays or weekends.

CONCLUSIONS

Children's MVPA was lower by 7-8 min/day in 2021 once restrictions were lifted than before the pandemic for all groups, on both weekdays and weekends. Previous research has shown that there is an undesirable age-related decline in children's physical activity. The 8-min difference reported here would be broadly comparable to the decline that would have previously been expected to occur over a three-year period. Parents' physical activity was similar to pre-pandemic levels. Our results suggest that despite easing of restrictions, children's activity levels have not returned to pre-pandemic levels. There is an urgent need to understand why these changes have occurred and how long they are maintained.

The hidden stigma of aging and COVID-19: aggravating factors and strategies to mitigate the impact of the pandemic in older adults, a text mining analysis

OBJECTIVE

To identify factors associated with mental health of older adults during the pandemic and to provide strategies to mitigate their psychosocial impact in the elderly.

METHOD

An integrative text mining analysis in Medline was performed to identify studies on the mental health of older adults during the pandemic. Subsequently, statistical topic modeling was performed to identify the most prevalent terms and topics discussed in included studies.

RESULTS

A total of 29 studies were retrieved until July 1st 2020, including a majority of letters (12 studies) and commentaries (8 studies). The most frequent terms overall were: loneliness (n = 137), support (n = 132), home (n = 102), suicide (n = 96) and help (n = 94). The most prevalent terms were then divided in five topics: home (33%), suicide (32%), apps (15%), loneliness (12%) and physical activity (9%). Additionally, a section focused on low- and middle-income countries was included. A summary of strategies to mitigate the effects of pandemic in mental health of older adults was also provided.

CONCLUSION

These factors demonstrate the importance of developing strategies for psychosocial support that take into consideration the particularities of the elderly. Different levels of care are immediately necessary to diminish the devastating impact of the pandemic in the mental health of older adults.

Multimodal Benefits of Exercise in Patients With Multiple Sclerosis and COVID-19

Multiple sclerosis (MS) is a demyelinating disease characterized by plaque formation and neuroinflammation. The plaques can present in various locations, causing a variety of clinical symptoms in patients with MS. Coronavirus disease-2019 (COVID-19) is also associated with systemic inflammation and a cytokine storm which can cause plaque formation in several areas of the brain. These concurring events could exacerbate the disease burden of MS. We review the neuro-invasive properties of SARS-CoV-2 and the possible pathways for the entry of the virus into the central nervous system (CNS). Complications due to this viral infection are similar to those occurring in patients with MS. Conditions related to MS which make patients more susceptible to viral infection include inflammatory status, blood-brain barrier (BBB) permeability, function of CNS cells, and plaque formation. There are also psychoneurological and mood disorders associated with both MS and COVID-19 infections. Finally, we discuss the effects of exercise on peripheral and central inflammation, BBB integrity, glia and neural cells, and remyelination. We conclude that moderate exercise training prior or after infection with SARS-CoV-2 can produce health benefits in patients with MS patients, including reduced mortality and improved physical and mental health of patients with MS.

The Effectiveness of the Integrated Care Model among Community-Dwelling Older Adults with Depression: A Quasi-Randomized Controlled Trial

Depression is the second-leading cause of disability among older patients worldwide. This study examined the effectiveness of the Integrated Care Model (ICM) intervention in decreasing depression, suicide ideation, and psychological symptoms and improving life satisfaction among old patients with depression living in communities. The participants were allocated to either the intervention (n = 67) or control group (n = 76) from July 2018 to November 2018. All participants received the usual geriatric care for three months in eastern Taiwan. Additionally, participants in the intervention group were treated according to the ICM, including the assessment and management of health problems, improvements in spiritual and mental wellbeing, helping with activities of daily life and mobility, providing social welfare resources, and prevention of elder abuse. The patients in the experimental group showed significant improvement in the group-by-time effect on the Center for Epidemiologic Studies Depression Scale, the Brief Symptom Rating Scale, suicide ideation measures, and the Life Satisfaction Index over 18 weeks. The ICM should be included in routine geriatric care and adopted in hospitals, long-term care facilities, and communities

Adolescents' Long-Term Experiences of Manageability, Comprehensibility, and Meaningfulness of a Group-Based Exercise Intervention for Depression

Physical exercise is a potentially effective treatment for adolescents with mild to moderate depression. However, there is a lack of long-term follow-ups to reveal adolescents’ experiences of exercise as a treatment for depression. The salutogenic concept of sense of coherence (SOC), comprising the domains manageability, comprehensibility, and meaningfulness is important to understand behaviour change. This study aimed to describe adolescents’ long-term experiences of manageability, comprehensibility, and meaningfulness of a group-based exercise intervention for depression. Fourteen adolescents with persistent depression were recruited from a psychiatric outpatient clinic and interviewed one year after participating in a 14-week moderate to vigorous exercise intervention for depression. An abductive qualitative content analysis was conducted, based on the three SOC domains manageability, comprehensibility, and meaningfulness. The results revealed that participation in the intervention was made manageable by a supportive environment, including: the intervention design, togetherness with peer group, and encouragement from adults. The comprehensibility of the intervention emerged through the insights regarding health benefits of exercise and the aim of the intervention. Meaningfulness was achieved through improved health behaviour, well-being and self-esteem, along with strengthened belief in the future and increased commitment to everyday life. The group-based exercise intervention was experienced as manageable, comprehensible, and meaningful.

Relationship Between Accelerometer-Based Physical Activity, Sedentary Behavior, and Mental Health in Young Finnish Men

Healthy lifestyle behaviors including physical activity (PA) have been recognized to contribute positively to mental health. Most of the evidence on relationship between PA and mental health relies on self-reported PA results. Device-based measures on PA or sedentary behavior (SB) are less frequently used in mental health research. The present study aimed at examining the relationship between mental health and PA/SB measured by accelerometers in young Finnish men. The sample consisted of 409 men (mean age 28 ± 7 years), who participated in the military refresher training in Finland. Self-rated mental health was measured with Mental Health Inventory (MHI-5) and short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) measuring mental health both from the perspective of mental health problems and mental well-being. PA was measured with accelerometer from the perspective of light, moderate, vigorous, and total activity, as well as SB. Linear regression models and compositional analysis were applied. Age, education, marital status, employment status, BMI, alcohol use and smoking were used as covariates. Evidence on relationship between total PA (standardized regression coefficient 0.340; 95% CI 0.022-0.657, p = 0.036) and SB (standardized regression coefficient -0.340; 95% CI -0.657 to -0.022, p = 0.036) with symptoms of mental health problems was found after adjusting for age, education, marital and employment status. The relationship was marginally significant (p = 0.056) after adjusting also for BMI, alcohol use and smoking. No evidence on relationship between PA or SB and mental well-being was found, neither in standard linear regression analysis nor in compositional approach. In our sample of young adult men, PA seemed to have a stronger relationship with symptoms of mental health problems rather than with mental well-being. The findings lead to a conclusion that all PA per se may not be independently associated with mental well-being in young adult males and raise the question whether the domain of PA and its context play a critical role in these relationships.

A new approach for reducing pollutants level: a longitudinal cohort study of physical exercises in young people

BACKGROUND

The present study aimed to evaluate the elimination of three common pollutants (dimethoate, benzo(a)pyrene (BaP) and bisphenol A (BPA) by different physical exercises and to assess the possible factors which could affect the pollutants elimination.

METHODS

A total of 200 individuals who chose different kinds of exercises in accordance to their own wish were recruited. The levels of urinary pollutants were measured using β-glucuronidase hydrolysis followed by a high-performance liquid chromatography tandem mass spectrometry-based method.

RESULTS

Totally, the levels of dimethoate, BaP and BPA were reduced after physical exercises. However, the elimination of BaP in male was higher than that in female but the elimination of BPA in female was higher than that in male. Multivariate logistic regression showed that the degree of heart rate (HR) change was a protective factor affecting the improvement effect of dimethoate, BaP and BPA while BMI (body mass index) was a risk factor. Nevertheless, sex was a risk factor affecting the improvement of dimethoate and BaP but had a lower efficacy on BPA improvement.

CONCLUSION

The present findings indicate that physical exercises can be considered as a novel approach to eliminate pollutants level in human body and can also give suggestions for choosing specific physical exercises to male and female individuals. Moreover, those who are with higher BMI need to lose weight before eliminating pollutant level through physical exercises.

Circadian Influences on the Habenula and Their Potential Contribution to Neuropsychiatric Disorders

The neural circadian system consists of the master circadian clock in the hypothalamic suprachiasmatic nuclei (SCN) communicating time of day cues to the rest of the body including other brain areas that also rhythmically express circadian clock genes. Over the past 16 years, evidence has emerged to indicate that the habenula of the epithalamus is a candidate extra-SCN circadian oscillator. When isolated from the SCN, the habenula sustains rhythms in clock gene expression and neuronal activity, with the lateral habenula expressing more robust rhythms than the adjacent medial habenula. The lateral habenula is responsive to putative SCN output factors as well as light information conveyed to the perihabenula area. Neuronal activity in the lateral habenula is altered in depression and intriguingly disruptions in circadian rhythms can elevate risk of developing mental health disorders including depression. In this review, we will principally focus on how circadian and light signals affect the lateral habenula and evaluate the possibility that alteration in these influences contribute to mental health disorders.

Muscle-to-Brain Signaling Via Myokines and Myometabolites

Skeletal muscle health and function are important determinants of systemic metabolic homeostasis and organism-wide responses, including disease outcome. While it is well known that exercise protects the central nervous system (CNS) from aging and disease, only recently this has been found to depend on the endocrine capacity of skeletal muscle. Here, we review muscle-secreted growth factors and cytokines (myokines), metabolites (myometabolites), and other unconventional signals (e.g. bioactive lipid species, enzymes, and exosomes) that mediate muscle-brain and muscle-retina communication and neuroprotection in response to exercise and associated processes, such as the muscle unfolded protein response and metabolic stress. In addition to impacting proteostasis, neurogenesis, and cognitive functions, muscle-brain signaling influences complex brain-dependent behaviors, such as depression, sleeping patterns, and biosynthesis of neurotransmitters. Moreover, myokine signaling adapts feeding behavior to meet the energy demands of skeletal muscle. Contrary to protective myokines induced by exercise and associated signaling pathways, inactivity and muscle wasting may derange myokine expression and secretion and in turn compromise CNS function. We propose that tailoring muscle-to-CNS signaling by modulating myokines and myometabolites may combat age-related neurodegeneration and brain diseases that are influenced by systemic signals.

Clinical Utility and Validity of Exercise Vital Sign in Children

ABSTRACT

We reviewed charts of 14,446 sports medicine patients, children aged 5 to 18 years, over a 3-year period to determine the discriminant validity of Exercise Vital Sign (EVS) questions. A logistic regression analyzed factors related to any moderate to vigorous physical activity (MVPA). A linear regression analyzed factors related to amount of MVPA for those who participated in any weekly MVPA. Overall, 48% of children reported meeting physical activity guidelines for 420 min·wk-1. Overall, children reported 400.36 ± 280.04 min·wk-1 of MVPA. Those with depression had significantly less MVPA than those without (95% confidence interval [CI], -96.65 to -26.31). Girls had significantly less MVPA than boys (95% CI, -59.15 to -40.31). Overweight and obese children reported less MVPA compared with normal weight children (95% CIs, -42.65 to -17.29 and -91.61 to -65.50, respectively). EVS demonstrates strong discriminant validity to detect differences between groups as a function of sex, body mass index, and depression.

Behavioural responses of Intensivists to stressors in Intensive Care

BACKGROUND

The hospital intensive care unit (ICU) environment encompasses sick patients who present for care in health crisis. Healthcare in this setting is complex, often involving the co-ordination of multiple professional teams, all under significant time pressures. The sequelae for staff interacting in this dynamic and often volatile setting are variable, depending upon their coping skillset and their familiarity with the stressors.

AIMS

The primary aim of this study was to describe and in doing so, normalize the behavioural responses expressed by ICU doctors (Intensivists) in response to stressful workplace events. The secondary aim was to identify those responses that contributed to resilience.

METHODS

A prospective qualitative study of senior Intensivists using a semi-scripted iterative interview. Data were transcribed and thematically analysed with verbatim quotations selected to support coding choices.

RESULTS

Nineteen experienced Intensivists from three sites in Australia and Israel participated. Clinicians described conscious, physiological and professional responses to stressors, including sense-making and taking time to process information with appropriate support. Two of the most important mitigation processes revealed were the use of reflective learning and preventative practice changes to prevent future errors. These were overlaid with the importance of disclosure and transparency in clinical work.

CONCLUSIONS

Repeated exposure to stressful events potentiates burnout, wherein staff no longer experience satisfaction and enjoyment in what they do. This paper presents the behavioural responses that experienced Intensivists described in relation to stressful events in the ICU, including steps taken to mitigate the effects of these events on their personal well-being.

Treadmill exercise sex-dependently alters susceptibility to depression-like behaviour, cytokines and BDNF in the hippocampus and prefrontal cortex of rats with sporadic Alzheimer-like disease

Alzheimer's disease (AD) is associated with increased depression-related behaviours. Previous studies have reported a greater risk of AD and depression in women. In recent years, we and others have provided evidence that exercise during life could be used as a therapeutic strategy for stress-related disorders such as depression. The main goal of the current study was to determine whether treadmill exercise during life can reduce depression-related behaviours in male and female Wistar rats with sporadic Alzheimer-like disease (ALD). Animals were subjected to treadmill exercise eight weeks before and four weeks after ALD induction by streptozocin (STZ). We measured body weight, food intake, and depression-related symptoms in rats using five behavioural tests. We measured brain-derived-neurotrophic factor (BDNF), tumour-necrosis factor (TNF)-α, and interleukin (IL)-10 levels in the hippocampus and prefrontal cortex of animals. Our findings showed that exercise but not ALD induction decreased body weight and food intake in male and female rats. ALD induction increased depression-related symptoms and hippocampal TNF-α in male and female rats. Besides, treadmill exercise alone decreased depression-related behaviours and increased hippocampal BDNF in females but not males. We also found that treadmill exercise decreased depression-related behaviours and TNF-α in the hippocampus and prefrontal cortex, and increased IL-10 in the prefrontal cortex and BDNF in the hippocampus of female ALD-induced rats. However, treadmill exercise only reduced anhedonia-like behaviour and hippocampal TNF-α in male ALD-induced rats. Overall, the evidence from this study suggests that treadmill exercise alters depression-related behaviours, brain BDNF and cytokines in a sex-dependant manner in rats with sporadic Alzheimer-like disease.

Prevalence and factors related to psychological distress among ethnic minority adults in a semi-modern village in rural Vietnam: an evolutionary mismatch framework

Background and objectives

Psychological distress is one of the greatest health threats facing humanity and has been hypothesized to represent an evolutionary mismatch. This hypothesis can be tested in semi-traditional societies that are undergoing transitions to modern lifestyles. This study used an evolutionary medicine framework to examine the predictors of psychological distress symptomology in a semi-modern ethnic minority village in rural Vietnam that is transitioning into a developing economy.

Methodology

A cross-sectional survey was conducted in Chieng Sai Village among White Thai ethnic minority adults aged 18-75. The DASS-21 scale was used to measure the prevalence of psychological distress symptoms (depression and stress), and a closed format questionnaire was used to collect data on independent variables within an evolutionary mismatch framework. Binary logistic regression analyses were used to determine associated factors of psychological distress symptomology.

Results

The prevalence of psychological distress symptoms was 22% (depression = 16.9%, stress = 16.3%). Common features of modernity, such as low levels of exercise, boredom, and low income, showed positive associations with psychological distress, while lifestyle features that were more similar to those expected in the evolutionary past and that fulfill evolutionary adaptations, such as getting enough sleep, adequate physical exertion, and access to resources (earning a sufficient income), showed negative associations with psychological distress.

Conclusions and implications

This study suggests that modern lifestyles might have generated evolutionary mismatches that are negatively impacting mental health in Chieng Sai Village. Further investigations on mental health in rural Vietnam are warrented. Future research should focus on determining the causal relationship between psychological distress and evolutionary mismatches. Evolutionary medicine approaches to understanding and preventing psychological distress are potential forces of insight to be considered in public health and educational policy.

Lay summary

Approximately 22% of White Thai ethnic minority adults in the village of Cheing Sai reported psychological distress symptoms. I found that lifestyle factors prevalent in modern society had positive associations with psychological distress symptomology, while lifestyle factors that mimic aspects of the human evolutionary past, such as adequate physical exertion, had negative associations with psychological distress symptoms.

"It's More Than Just Exercise": Tailored Exercise at a Community-Based Activity Center as a Liminal Space along the Road to Mental Health Recovery and Citizenship

Mental health care policies call for health-promoting and recovery-oriented interventions, as well as community-based programs supporting healthier habits. The purpose of this study was to explore how individuals facing mental health challenges experienced participating in tailored exercise at a community-based activity center, and what role tailored exercise could play in supporting an individual’s process of recovery. Data were collected through in-depth interviews with nine adults experiencing poor mental health who engaged in exercise at the activity center. Interviews were audio-recorded, transcribed verbatim and analyzed using systematic text condensation. Participants spoke about the community-based program being a safe space where they could “come as they are” (Theme 1). Taking part in the program was “more than just exercise” and allowed them to connect with others (Theme 2). The experiences they gained from exercise also helped with other areas in life and provided them with a safe space to build their confidence towards the “transition back to the outside” (Theme 3). We summarized the findings into one overall theme: “inside vs. outside”. In conclusion, a community-based activity center acted as a liminal space that aided mental health recovery by allowing participants to feel safe, accepted and supported, as well as experience citizenship. The findings highlight the need to treat mental health challenges as a contextual phenomenon and creating arenas for community and citizenship in society.

The effect of physical activity on anhedonia in individuals with depressive symptoms

The therapeutic effect of antidepressants has been demonstrated for anhedonia in patients with depression. However, antidepressants may cause side-effects, such as cardiovascular dysfunction. Although physical activity has minor side-effects, it may serve as an alternative for improving anhedonia and depression. We sought to investigate whether physical activity reduces the level of anhedonia in individuals with depression. Fifty-six university students with moderate depressive symptoms (Beck Depression Inventory total score > 16) were divided into three training groups: the Running Group (RG, n = 19), the Stretching Group (SG, n = 19), and the Control Group (n = 18). We employed the Monetary Incentive Delay (MID) task and the Temporal Experience of Pleasure Scale (TEPS) to evaluate hedonic capacity. All participants in the RG and SG received 8 weeks of jogging and stretching training, respectively. The RG experienced an increase in the level of arousal during anticipation of a future reward and recalled less negativity towards the loss condition. The SG exhibited enhanced scores on the Anticipatory and Consummatory Pleasure subscales of the TEPS after training. Moreover, in the RG, greater improvements in anticipatory arousal ratings for pleasure and remembered valence ratings for negative affect were associated with longer training duration, lower maximum heart rate, and higher consumed calories during training. To conclude, physical activity is effective in improving anticipatory anhedonia in individuals with depressive symptoms.

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

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

Better together: How group-based physical activity protects against depression

Against the backdrop of evidence that physical activity can protect against depression, there has been growing interest in the mechanisms through which this relationship operates (e.g., biological adaptations), and the factors that might moderate it (e.g., physical activity intensity). However, no attempt has been made to examine whether, or through what mechanisms, depression-related benefits might arise from belonging to groups that engage in physical activity. Across two studies, we addressed these shortcomings by (a) examining whether engaging in physical activity specifically in the context of sport or exercise groups protects against depression and (b) testing two pathways through which benefits might arise: greater physical activity and reduced loneliness. Study 1 (N = 4549) used data from three waves of a population study of older adults residing in England. Sport or exercise group membership predicted fewer depression symptoms four years later. This relationship was underpinned by sport or exercise group members engaging in physical activity more frequently and feeling less lonely. Clinical depression rates were almost twice as high among non-group members than group members. Study 2 (N = 635) included Australian adults who were members of sport and exercise groups, recruited during the enforced suspension of all group-based sport and exercise due to COVID-19 restrictions. The more sport or exercise groups participants had lost physical access to, the more severe their depression symptoms. Clinical depression rates were over twice as high among those who had lost access to >2 groups compared to those who had lost access to <2 groups. The relationship between number of groups lost and depression symptom severity was mediated by greater loneliness, but not by overall physical activity. Overall, findings suggest that belonging to groups that engage in physical activity can protect against depression, and point to the value of initiatives that aim to promote people's engagement in such groups.

Multidimensional analyses of the effect of exercise on women with depression: A meta-analysis

BACKGROUND

The proportion of women is higher than men in depression. This is mainly due to women's physiological regulation is different from men, especially in puberty, menstruation, pregnancy, menopause, among others. Therefore, treating depressive women is still a health challenge. Besides, recent studies of exercise therapy have a more outstanding performance in treating depression, especially in contrast to drug therapy and psychotherapy. Its main advantages are convenience, quickness, no side effects, real-time, and long-term effectiveness.

OBJECTIVE

The aim of this study was to systematically review the clinical efficacy of exercise on women with depressive symptoms.

METHODS

Searching PubMed, The Cochrane Library, and Embase databases to collect randomized controlled trials about exercise in the treatment of depressive women. After literature screening, data extraction, and literature quality evaluation, the meta-analysis of acquirement data was performed with RevMan5.3 software.

RESULTS

A total of 2294 patients were included in 25 different articles totally. Meta-analysis shows that compared with the control group, exercise could relieve female depression (standard mean difference [95% confidence interval, CI] = -0.64 [-0.89 to -0.39], Z = 4.99, P < .001). Subgroup analysis shows that different types of exercise have significant effects in improving depression symptoms. Exercise therapy has better effect on depressive patients induced by physiology or disease than ordinary depressive patients.

CONCLUSION

Exercise can significantly improve depressive symptoms in women.

The Psychological Restorative Effects of Campus Environments on College Students in the Context of the COVID-19 Pandemic: A Case Study at Northwest A&F University, Shaanxi, China

During the COVID-19 outbreak, college students experienced different periods of isolation on campus, which has had an impact on students' mental health. Based on ART theory, this study randomly selected students at Northwest A&F University, Shaanxi, China and distributed questionnaires in order to evaluate the psychological recovery effect of campus environment during the epidemic. The results showed that: (1) There were significant differences in the psychological restoration of four types of campus environments. Blue space had the greatest effect, followed by green space and sports grounds, while grey space had the least. (2) Time of stay had a very significant impact on psychological restoration. Longer time of exposure is not necessarily correlated with a better recovery experience. (3) In the different campus environments, extent is easier to be perceived followed by fascination and compatibility, and the weakest is being away. At the time of stay level, no significant difference was found in the perception of compatibility. Time of stay was negatively correlated with fascination and compatibility. These findings can provide theoretical and practical bases for campus environmental planning and construction following the COVID-19 epidemic.

PHYSICAL EXERCISES IN RELIEVING THE CURRENT STATE OF DEPRESSION

ABSTRACT Introduction: Physical exercise has become a common method at home and abroad as a means of psychotherapy and mental health. Objective: Observing the current situation and characteristics of physical exercise and depressive disorders and examining the influence of physical exercise on depressive disorders in the human body. Methods: The article compares and analyzes the relationship between human physical exercise and the level of depression and body self-esteem from the perspective of psychology. Results: The incidence of depression is higher. There are significant differences in the attitude towards physical exercise and the degree of depression in the three types of subjects in the study. Physical exercise is conducive to the relief of depression. Conclusion: Physical exercise is one of the effective ways to improve the depressive state of the human body. The effect of an exercise has no relation with the specific exercise method selected. Level of evidence II; Therapeutic studies - investigation of treatment results.

Does baseline leisure-time physical activity level predict future depressive symptoms or physical activity among depressive patients? Findings from a Finnish five-year cohort study

OBJECTIVES

The aims of this study were to investigate whether baseline leisure-time physical activity (LTPA) is associated with future recovery from depression among patients with a depression diagnosis and whether baseline LTPA is associated with total physical activity after five years of follow-up.

METHODS

A total of 258 patients aged ≥35 years with clinically confirmed depression at baseline participated. The study was conducted between 2008 and 2016 in municipalities within the Central Finland Hospital District. Depressive symptoms (DS) were determined with the Beck Depression Inventory (BDI) with a cutoff score ≥10, and depression diagnoses were confirmed by the Mini-International Neuropsychiatric Interview (MINI). Blood pressure and anthropometric parameters were measured and blood samples for glucose and lipid determinations were drawn at baseline. LTPA, physical activity, and other social and clinical factors were captured by standard self-administered questionnaires at baseline and the five-year follow-up point.

RESULTS

Of the 258 patients, 76 (29%) had DS at follow-up. Adjusted odds ratio (OR) for future DS was 1.43 (confidence interval [CI] 0.69-2.95) for participants with moderate LTPA and 0.92 (CI 0.42-2.00) for participants with high LTPA, compared with low LTPA at baseline. Higher baseline LTPA levels were associated with higher total physical activity in the future (β=0.14 [95% CI: 0.02-0.26] for linearity = 0.024).

CONCLUSION

Baseline LTPA did not affect the five-year prognosis of depression among depressed patients in a Finnish adult population. Because the baseline LTPA level predicted the future total physical activity, it could be included as a part of the overall health management and treatment of depression in clinical practices.

Combination of acupuncture and medical training therapy on tension type headache: Results of a randomised controlled pilot study

OBJECTIVES

The aim of this study was to compare the effects of acupuncture and medical training therapy alone and in combination with those of usual care on the pain sensation of patients with frequent episodic and chronic tension-type headache.

DESIGN

This was a prospective single-centre randomised controlled trial with four balanced treatment arms. The allocation was carried out by pre-generated randomisation lists in the ratio 1:1:1:1 with different permutation block sizes.

SETTING

The study was undertaken in the outpatient clinic of Rehabilitation Medicine of the Hannover Medical School.Participants and interventions: Ninety-six adult patients with tension-type headache were included and randomised into usual care (n = 24), acupuncture (n = 24), medical training (n = 24), and combination of acupuncture and medical training (n = 24). One patient was excluded from analysis because of withdrawing her/his consent, leaving 95 patients for intention to treat analysis. Each therapy arm consisted of 6 weeks of treatment with 12 interventions. Follow-up was at 3 and 6 months.

MAIN OUTCOME MEASURES

Pain intensity (average, maximum and minimum), frequency of headache, responder rate (50% frequency reduction), duration of headache and use of headache medication.Clinical results: The combination of acupuncture and medical training therapy significantly reduced mean pain intensity compared to usual care (mean = -38%, standard deviation = 25%, p = 0.012). Comparable reductions were observed for maximal pain intensity (-25%, standard deviation = 20%, 0.014) and for minimal pain intensity (-35%, standard deviation = 31%, 0.03). In contrast, neither acupuncture nor medical training therapy differed significantly from usual care. No between-group differences were found in headache frequency, mean duration of headache episodes, and pain medication intake. At 3 months, the majority of all patients showed a reduction of at least 50% in headache frequency. At 6 months, significantly higher responder rates were found in all intervention groups compared to usual care.

CONCLUSIONS

In contrast to monotherapy, only the combination of acupuncture and medical training therapy was significantly superior in reduction of pain intensity compared to usual care.Trial registration: Registered on 11 February 2019. German Clinical Trials Register, DRKS00016723.

Is There an Association Between Diet, Physical Activity and Depressive Symptoms in the Perinatal Period? An Analysis of the UPBEAT Cohort of Obese Pregnant Women

INTRODUCTION

Depression is a common morbidity of the perinatal period (during pregnancy and up to one year postpartum). There is evidence for an association between diet and physical activity, and depression in the non-pregnant population but this association has been relatively less explored during the perinatal period; particularly poorly understood is the relationship between specific dietary components and depression. The aim of this study was to explore the association between glycaemic load, saturated fat intake and physical activity and depressive symptoms in a high-risk population of obese pregnant women.

METHODS

In a cohort of 1522 women participating in the UPBEAT trial, physical activity, glycaemic load and saturated fat intake were used as predictors of depressive symptoms measured using the Edinburgh Postnatal Depression Scale (EPDS). Measures taken in early pregnancy were used in linear and logistic regression models. Repeated measures at three points during pregnancy and at six months postpartum were utilised in multilevel mixed effects models. Multiple imputation was used to account for missing data.

RESULTS

Increased glycaemic load was associated with small increases in levels of depressive symptoms across the perinatal period (adjusted beta coefficient 0.01; 95% CI 0.01,0.02). There was no evidence for an association between reduced physical activity and increased saturated fat intake and increased levels of depressive symptoms.

CONCLUSIONS

Glycaemic load may be a useful focus for interventions aiming to optimise the mental health of obese women in the perinatal period.

The Effect of Hyperbaric Oxygen Combined with Virtual Reality Training on Oxidative Stress Indicators and Inflammatory Factors of Swimming Athletes Suffering from Depression

This study was conducted to explore the effect of hyperbaric oxygen (HBO) therapy combined with virtual reality (VR) training on oxidative stress indicators (OSIs) and inflammatory factors (IFs) in swimming athletes with depression. 88 swimming athletes suffering from depression were grouped into a control group (group C) and a research group (group R). The patients in group C were given HBO therapy, and the group R was given HBO therapy combined with VR training. The Physical Health Questionnaire (PHQ-9) and the Symptom Checklist (SCL-90) were adopted to assess the depression status of patients. The differences between the two groups of serum OSIs and IFs before and after the intervention were compared and analyzed. The results disclosed that the PHQ-9 score and SCL-90 score in group R were not different from those in group C before the intervention, but those in group R were greatly decreased in contrast to group C after the intervention ( $P<0.05$ ). Before the intervention, there was no obvious difference in the OSIs and the IFs between the two groups. The levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) in the two groups were decreased greatly after intervention, and those in the group R were much lower than those in group C ( $P<0.05$ ). Compared with the preintervention, the levels of malondialdehyde (MDA) in both groups were reduced observably, and the levels of superoxide dismutase (SOD), nitric oxide (NO), and glutathione peroxidase (GSH-Px) were dramatically increased. The MDA in group R was much lower, while the SOD, NO, and GSH-Px were much higher in contrast to group C ( $P<0.05$ ). It indicated that HBO combined with VR training had a good clinical effect for swimming athletes suffering from depression, and it could reduce the oxidative stress and inflammation, thereby helping patients recover quickly.

L-lactate induces neurogenesis in the mouse ventricular-subventricular zone via the lactate receptor HCA1

AIM

Adult neurogenesis occurs in two major niches in the brain: the subgranular zone of the hippocampal formation and the ventricular-subventricular zone. Neurogenesis in both niches is reduced in ageing and neurological disease involving dementia. Exercise can rescue memory by enhancing hippocampal neurogenesis, but whether exercise affects adult neurogenesis in the ventricular-subventricular zone remains unresolved. Previously, we reported that exercise induces angiogenesis through activation of the lactate receptor HCA1. The aim of the present study is to investigate HCA₁ -dependent effects on neurogenesis in the two main neurogenic niches.

METHODS

Wild-type and HCA₁ knock-out mice received high intensity interval exercise, subcutaneous injections of L-lactate, or saline injections, five days per week for seven weeks. Well-established markers for proliferating cells (Ki-67) and immature neurons (doublecortin), were used to investigate neurogenesis in the subgranular zone and the ventricular-subventricular zone.

RESULTS

We demonstrated that neurogenesis in the ventricular-subventricular zone is enhanced by HCA₁ activation: Treatment with exercise or lactate resulted in increased neurogenesis in wild-type, but not in HCA₁ knock-out mice. In the subgranular zone, neurogenesis was induced by exercise in both genotypes, but unaffected by lactate treatment.

CONCLUSION

Our study demonstrates that neurogenesis in the two main neurogenic niches in the brain is regulated differently: Neurogenesis in both niches was induced by exercise, but only in the ventricular-subventricular zone was neurogenesis induced by lactate through HCA₁ activation. This opens for a role of HCA₁ in the physiological control of neurogenesis, and potentially in counteracting age-related cognitive decline.

Qualitative Evaluation Informs Understanding of Motor Cognition and Therapies in Older Adults with Mild Cognitive Impairment

BACKGROUND

10%to 20%of Americans aged 65 and older have mild cognitive impairment (MCI) with 10%progressing to Alzheimer's disease (AD) each year. Underserved groups, including African Americans (AAs), are among the most vulnerable to MCI and AD. Although evidence continues to amass, the benefits of exercise and movement for AD is still understudied in AD.

OBJECTIVE

Understanding the attitudes, perceptions, and beliefs about motor-cognitive integration and examining the physical activity of a sample of predominantly Black women community members with self-reported memory problems will allow improved recruitment and refinement of multimodal interventions designed to improve motor-cognitive and cognitive function.

METHODS

We conducted focus groups with older adults who reported subjective memory complaints (n = 15; Black: n = 12, White: n = 3, mean age 71.7±5.8).

RESULTS

Findings from thematic analysis showed most participants knew of benefits of exercise. However, most participants reported not getting adequate exercise due to factors such as pain, increased responsibilities, and fear of injury. Despite barriers, participants expressed enthusiasm for multimodal interventions designed to target body and brain health and provided several suggestions to improve or enhance the proposed interventions.

CONCLUSION

Results provide useful insights regarding improving participation among historically under-represented groups in clinical movement-based research. Participants' discussion focused primarily on the way motor-cognitive integration prevents falls, maintains memory, and provides a social benefit. The reported perceived benefits and limitations of exercise, as this population understands it, can help researchers and physicians better engage the community for lifestyle changes that will support greater motor-cognitive health.

Exploring changes in body image, eating and exercise during the COVID-19 lockdown: A UK survey

Early reports suggest that lockdown measures associated with the COVID-19 pandemic (e.g., social distancing) are having adverse consequences for people's mental health, including increases in maladaptive eating habits and body dissatisfaction. Certain groups, such as those with pre-existing mental health difficulties, may be especially at risk. The current study explored perceived changes in eating, exercise, and body image during lockdown within the United Kingdom, using an online survey (n = 264). There were large individual differences in perceived changes in eating, exercise, and body image in this period. Women were more likely than men to report increasing struggles with regulating eating, preoccupation with food and worsening body image. Those with a current/past diagnosis of eating disorders reported significantly greater difficulties in regulating eating, increased preoccupation with food, exercise thoughts and behaviours and concern about appearance, even when compared to those with other mental health and developmental disorders. Ongoing research to explore individual differences in the trajectories of change in eating, exercise and body image as lockdown measures ease will be important for understanding the full psychological impact of this pandemic and improve service and public health planning going forward.

Reliability and Convergent Validity of Self-Reported Physical Activity Questionnaires for People With Mental Disorders: A Systematic Review and Meta-Analysis

PURPOSE

To examine the reliability and convergent validity of self-reported questionnaires (SRQs) to measure physical activity (PA).

METHODS

Systematic review with meta-analysis. The validity and reliability of SRQs to assess PA in people with mental disorders (January 20, 2020). Random-effects meta-analyses were performed pooling (1) test-retest correlations or (2) the convergent validity between the SRQs and objective measures (eg, accelerometry). Associations were provided in r values with the 95% confidence interval. Methodological quality was assessed.

RESULTS

A total of 9 unique studies (N = 1344; 40.5% females) were included. The authors found a moderate correlation test-retest reliability for PA SRQs in the assessment of vigorous PA (r = .69 [.38 to .85]; P = .001), moderate to vigorous PA (r = .63 [.25 to .84]; P = .003), moderate PA (r = .63 [.39 to .79]; P = .001), and good correlation total PA (r = .75 [.37 to .92]; P = .001). The SRQs have moderate correlations with objective measures for moderate to vigorous PA (r = .25 [.18 to .32]; P = .0001) and total PA (r = .47 [.28 to .62]; P = .005), a poor correlation for moderate PA (r = .18 [.03 to .36]; P = .047), and no correlation with vigorous PA (r = .06 [-.10 to .22]; P = .440).

CONCLUSION

Current evidence indicates that SRQs are reliable over time to assess moderate, vigorous, and total PA levels and valid when assessing moderate PA.

Social determinants and other aspects associated with rheumatic diseases in the Brazilian population: a cross-sectional study based on the National Health Survey (PNS2013)

Background

Rheumatic diseases are increasingly present in the world population, represented by chronic joint and musculoskeletal pain. Among them, osteoarthritis (OA) is the most prevalent. It is considered the third most prevalent chronic non-communicable disease in the Brazilian population, being responsible for a high rate of physical disability and reduced quality of life. Little has been discussed about the social factors associated with this health condition. This study aimed to analyze the social factors associated with arthritis in the Brazilian population.

Methods

This is a cross-sectional study based on data from the 2013 National Health Survey in Brazil with arthritis as its main outcome. Sex, age, body weight, usual activities, physical activity, self-perceived health and diagnosis of depression were analyzed as independent variables. Descriptive and inferential statistics were used. Poisson multiple regression was performed, and the prevalence ratio (PR) and confidence interval (CI) of 95% were calculated using a significance level of 5% (p ≤ 0.05).

Results

A total of 60,202 individuals of both sexes took part in this study and the rheumatic diseases or arthrtitis prevalence was 6.4%. The individual factors associated with a higher prevalence of arthritis were female (PR = 2.09; CI = 1.95–2.25), age over 35 years (PR = 2.88; CI = 2.57–3.24) and excess body weight (PR = 1.61; CI = 1.25–2.07). The presence of rhemautic diseases showed an association with lower performance of usual activities (PR = 1.61; CI = 1.50–1.73) and self-perceived health as very poor (PR = 3.96; CI = 3.31–4.72). In addition, it was associated with a higher prevalence of mental illnesses such as depression (PR = 1.77; CI = 1.64–1.90).

Conclusion

Social and modifiable factors which are associated with a higher prevalence of arthritis can be controlled through incentive measures such as social participation and physical activity.

Physical and Psychological Effects Related to Food Habits and Lifestyle Changes Derived from Covid-19 Home Confinement in the Spanish Population

As a consequence of COVID-19, millions of households have suffered mobility restrictions and changes in their lifestyle over several months. The aim of this study is to evaluate the effects of COVID-19 home confinement on the food habits, lifestyle and emotional balance of the Spanish population. This cross-sectional study used data collected via an anonymous online questionnaire during the month before lockdown finished in Spain, with a total of 675 participants. 38.8% of the respondents experienced weight gain while 31.1% lost weight during confinement. The increase in body weight was positively correlated with age (Rs = 0.14, p < 0.05) and BMI (Rs = 0.20, p < 0.05). We also identified that 39.7% reported poorer quality sleep, positively correlated with BMI (Rs = -0.18, p < 0.05) and with age (Rs = -0.21, p < 0.05). 44.7% of the participants had not performed physical exercise during confinement with differences by sex (p < 0.05), by age (p < 0.05), by BMI (p < 0.05) and by sleep quality (p < 0.05). According to an emotional-eater questionnaire, 21.8% and 11% were classified as an emotional eater or a very emotional eater, respectively. We emphasize the importance of adopting a healthy lifestyle, as the COVID-19 pandemic is ongoing.

Physical activity and ability to meet different work requirements among adult working men with or without current depressive symptoms

Purpose

To examine the relationship between leisure-time physical activity (LTPA) and ability to meet different work requirements among adult working men with or without current depressive symptoms.

Methods

We measured LTPA with the long version of the International Physical Activity Questionnaire (IPAQ). The Work Ability Index (WAI) and Beck Depression Inventory (BDI) were used to assess the work ability and depression of 921 Finnish employed male volunteers. Participants were divided into three groups according to the WAI for their work requirements: mental (MENT), physical (PHYS), and an equal amount of mental and physical work (BTH).

Results

When adjusted for age, BMI and employment years, there was a significant difference in weekly LTPA between WAI groups {p = 0.003, [F (2902) = 5.58]}, but not for depression. It appeared that participants with depressive symptoms scored lower WAI in each group regardless of LTPA. In addition, a linear relationship was found between higher LTPA and WAI in nondepressed workers in the PHYS [p = 0.011, β = 0.10 (95% CI 0.03–0.18)] and BTH [p = 0.027, β = 0.19 (95% CI 0.03–0.34)] groups. Among workers with depressive symptoms, similar linearity was found in BTH [p = 0.003, β = 0.20 (95% CI 0.03–0.55)]. In group-wise comparison, work requirements {p = 0.001, [F (2902) = 11.2]} and depressive symptoms {p < 0.001, [F (1902) = 177.0]} related with lower WAI.

Conclusion

Depressive symptoms were associated with lower work ability regardless of the job description. Therefore, higher levels of weekly LTPA was linked with better work ability among nondepressed working men. Workers with depressive symptoms in jobs that require extensive mental or physical work might need more than exercise to improve work ability.

Electronic supplementary material

The online version of this article (10.1007/s00420-020-01595-6) contains supplementary material, which is available to authorized users.

The effects of physical activity and sedentary behavior in the associations between cardiovascular diseases and depression: A four-way decomposition

BACKGROUND

Negative effects of cardiovascular diseases (CVDs) on depression have been reported, but the relative contribution of physical activity (PA) and sedentary behavior (SB) to such effects remains unclear. Our objective was to precisely quantify the effects modified or mediated by PA and SB using the recently developed four-way effect decomposition.

METHODS

Our analysis included 22,117 adults (aged≥20 years) participating in the 2007-2016 National Health and Nutrition Examination Survey (NHANES). Depression was assessed by the Patient Health Questionnaire-9. Moderate recreational activity (MRA), moderate work activity (MWA), and walk or bicycle for transportation, were measured by the Global Physical Activity Questionnaire (GPAQ). A four-way decomposition was applied with PA and SB as mediator to decompose the total effects of CVDs on depression into four components: controlled direct effect (CDE), pure indirect effect (PIE), reference interaction (INT_ref), and mediated interaction effect (INT_med).

RESULTS

There were statistically significant associations between CVDs, MRA, and depression, with the adjusted odds ratios (95% confidence intervals) of being 1.73 (1.42~2.30), 1.81 (1.42~2.30), respectively. With MRA as a mediator, there were interaction and mediation effects in the associations between CVDs and depression, and the proportions attributable of INT_ref, INT_med, and PIE were 94.08% (P<0.001), 3.92% (P = 0.007), and 1.68% (P = 0.006), respectively. Furthermore, the mediation effect was statistically significant in females rather than males.

CONCLUSIONS

MRA strongly modified and mediated the effects of CVDs on depression, especially in females. Our results suggested that sufficient MRA (at least 150 min per week) was considered as requirement for preventing depression in CVDs patients in females.

Mental health literacy, treatment preferences and the lived experience of mental health problems in an Australian cancer sample

OBJECTIVES

The prevalence rates for mental health (MH) problems in cancer patients is high, although reduced uptake of services may be influenced by mental health literacy (MHL). The objective of this study was to investigate the MHL for depression and panic disorder (PD), including treatment preferences in Australian adults who had been diagnosed and treated for cancer, and whether MHL and treatment preferences was influenced by sex, age, and individuals' lived MH experience.

METHOD

A total of 421 cancer survivors (n = 378 females) completed a self-report survey. Participants were asked to specify whether they had a lived experience with anxiety and/or depression, and to indicate treatment preferences for managing cancer-related distress. Two vignettes were administered to assess MHL for depression and PD.

RESULTS

The MHL accuracy for depression was higher than PD. Accuracy rates were higher for females with a lived experience with anxiety and/or depression; although the accuracy rate for PD was significantly lower in males. A high proportion of individuals preferred exercise and in-person counselling to manage depression and PD. Internet-based therapies were not strongly preferred for managing MH problems.

CONCLUSIONS

The MHL for depression and PD is moderate for adult cancer survivors, with higher levels indicated for individuals with a personal lived experience with anxiety and/or depression. Public health campaigns for enhancing MHL should broaden to include individuals experiencing comorbid physical health conditions. Health providers also need to take into account client preferences for evidence-based therapies.

Relationship between different domains of physical activity and positive mental health among young adult men

Background

There is growing evidence on positive effects of physical activity (PA) on mental health. However, the focus of previous research on this relationship has typically been on mental health from the perspective of mental health problems rather than from the perspective of mental wellbeing. Further, previous research has commonly focused rather on leisure time PA without evidence on the role of other domains of PA. The aim of the present cross-sectional study was to investigate the relationship between positive mental health (PMH) and different domains of PA in young Finnish men. The secondary aim was to examine the reasons for physical inactivity among individuals with a low level of PMH.

Methods

Positive mental health (measured with Short Warwick-Edinburgh Mental Wellbeing Scale, SWEMWBS), self-reported leisure time, occupational and commuting PA as well as reasons for physical inactivity were measured using questionnaires (n = 456, mean age 29 years) among young Finnish males. Logistic regression modelling was used to generate odds for low and high levels of positive mental health for different levels of PA and sociodemographic variables.

Results

A weak positive association between leisure time PA and PMH was found in men with a low level of PMH (OR = 0.33, 95% CI 0.13–0.86). No association was found in the domains of commuting and occupational PA. Multivariate logistic regression analysis showed lower level of leisure time PA, unemployment and being single independently predicting low level of PMH. No associations were found between any domains of PA and high level of PMH. The most common reasons for physical inactivity among men with a low level of PMH were lack of interest (28%) and unwillingness to practise sports alone (27%).

Conclusions

The relationship between physical activity and positive mental health seems to vary between different domains of physical activity. The findings highlight the important role of leisure time physical activity, particularly in men with a low level of positive mental health. Strategies aimed at increasing physical activity for mental health benefits should focus particularly on providing opportunities for leisure time physical activity involving social interactions for men with lower mental wellbeing.

Physical activity-mediated associations between perceived neighborhood social environment and depressive symptoms among Jackson Heart Study participants

BACKGROUND

Little is known about the associations between perceived neighborhood social environment (PNSE) and depressive symptoms among African Americans. Furthermore, the role of physical activity (PA) as a mediator of this association has not been investigated. The two-fold objectives of this study, therefore, were (1) to examine the associations between PNSE and depressive symptoms among African Americans, and (2) to test the degree to which these associations were mediated by total PA.

METHODS

We used baseline data from the Jackson Heart Study (JHS), a single-site, prospective, community-based study of African-American adults (n = 2209) recruited from Jackson, Mississippi. PNSE variables included scores for neighborhood violence (i.e., higher score = more violence), problems (higher score = more problems), and social cohesion (higher score = more cohesion). Depressive symptoms were measured by the 20-item Center for Epidemiological Studies Depression (CES-D) score. First, multilevel modeling, controlling for census tract clustering effects, was used to estimate associations between each PNSE variable and CES-D score, adjusting for covariates, including demographic, health-related, and population density. Second, validated, self-reported total PA, based on active living, sport, and home indices, was tested as the mediator. Multivariable linear regressions with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) were estimated to test for significant unstandardized indirect effects, controlling for all covariates.

RESULTS

Our participants were 64.2% female with a mean age of 52.6 (SD = 12.2) and a mean CES-D score of 10.8 (SD = 8.1). In the fully-adjusted model, neighborhood violence and problems were positively related to depressive symptoms (B = 3.59, 95%CI = 0.93, 6.26, and B = 3.06, 95%CI = 1.19, 4.93, respectively). Neighborhood violence and problems were also indirectly related to depressive symptoms via total PA (B = 0.26, 95%BC CI = 0.05, 0.55; and B = 0.15, 95%BC CI = 0.02, 0.34, respectively). Social cohesion was neither directly nor indirectly related to depressive symptoms.

CONCLUSIONS

We found that higher levels of perceived neighborhood problems and violence were directly and positively associated with depressive symptoms. These associations may be explained in part by lower total PA levels. Future interventions to reduce depressive symptoms attributed to neighborhood features should consider emphasizing built environment features that facilitate PA increases in conjunction with community efforts to reduce neighborhood violence and problems.

A grounded theory of adoption and maintenance of physical activity among autistic adults

Background:

Although a growing body of literature has explored the physical activity experiences from the perspective of children on the autism spectrum, the perspective of autistic adults remains largely unheard. Due to this absence of perspective, there exists limited knowledge of the appropriateness and generalizability of current models and theories of physical activity for this population.

Methods:

A constructivist grounded theory study was conducted to explore the experiences of adoption and maintenance of physical activity from the direct perspective of autistic adults. Autistic adults ( n = 23) from the United States and the United Kingdom were recruited.

Results:

A total of 29 codes emerged from the coding process. These codes were formed into four broad categories: (1) individual attributes; (2) environmental factors; (3) social relationships; and (4) social experiences. The interconnectedness of these four categories was explored.

Conclusions:

The findings and presented model highlight the importance of building successful experiences for young children on the autism spectrum, so that they are more likely to continue physical activity into their adult life. Furthermore, findings emphasize the importance of creating noncompetitive, sensory-friendly physical activity experiences for autistic adults that offer flexibility in social engagement.

Lay abstract

Little is known about how autistic adults experience physical activity. To begin to change this, we interviewed 23 autistic adults from the United State and the United Kingdom about their past and current experiences of physical activity participation. The interviewees told us about how their physical activity experiences were highly influenced by their individual strengths, the setting in which the activity took place, the presence of people to support their physical activities, and the sensory experiences they had while in physical activity. Through these interviews, we were able to create a model that represented the physical activity experiences discussed. Based on the model that emerged from this study, we recommend physical activity opportunities are made available that are noncompetitive, sensory-friendly, and that allow for participants to socialize as they prefer.