A pragmatic randomised controlled trial of preferred intensity exercise in depressed adult women in the United Kingdom: secondary analysis of individual variability of depression

BACKGROUND

This study is a secondary analysis of the trial by Callaghan et al. (2011), which reported higher antidepressant effects for preferred intensity (n = 19) vs. prescribed intensity (n = 19) exercise of three sessions/week over four weeks in depressed women. In particular, the present study sought to examine whether greater clinically significant individual change/recovery was observed in the preferred compared to the prescribed exercise group.

METHODS

The reliable change index and the C_cutoff score criteria described by Jacobson and Truax (1991) were employed to determine clinical significance. These criteria examined if individual change in depression scores from pre- to post-intervention in the preferred intensity group were statistically significant beyond the standard error of difference derived from the active comparator prescribed group, and subsequently within a normal population range. Patients fulfilling the first or both criteria were classified as improved or recovered, respectively.

RESULTS

Post-intervention depression scores of six patients in the preferred intensity exercise group (32%) demonstrated statistically reliable improvement (p < 0.05) and recovery. Half of this subgroup started as moderately depressed. No patient demonstrated a reliable deterioration in depression. Due to a small sample size, it was impossible to determine whether patients on psychiatric medication or medication-free patients were equally benefited from preferred intensity exercise. Thirteen patients in the preferred intensity group (68%) displayed non-statistically significant change in post-intervention depression scores (p > 0.05), although eight of them showed a non-significant improvement in post-intervention depression scores and three could not technically show an improvement in depression due to floor effects (baseline depression within normal range).

CONCLUSIONS

Preferred intensity exercise of three sessions/week over four weeks led almost a third of the patients to record scores consistent with recovery from depression. Health professionals may consider that short-term preferred intensity exercise provides clinically significant antidepressant effects comparing favourably to exercise on prescription.

Potential exerkines for physical exercise-elicited pro-cognitive effects: Insight from clinical and animal research

A sedentary lifestyle is now known as a critical risk factor for accelerated aging-related neurodegenerative disorders. In contract, having regular physical exercise has opposite effects. Clinical findings have suggested that physical exercise can promote brain plasticity, particularly the hippocampus and the prefrontal cortex, that are important for learning and memory and mood regulations. However, the underlying mechanisms are still unclear. Animal studies reveal that the effects of physical exercise on promoting neuroplasticity could be mediated by different exerkines derived from the peripheral system and the brain itself. This book chapter summarizes the recent evidence from clinical and pre-clinical studies showing the emerging mediators for exercise-promoted brain health, including myokines secreted from skeletal muscles, adipokines from adipose tissues, and other factors secreted from the bone and liver.

The impact of lifestyle Physical Activity Counselling in IN-PATients with major depressive disorders on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers: study protocol for a randomized controlled trial

BACKGROUND

Major depressive disorder (MDD) is a widespread and burdensome psychiatric issue. Physical activity counselling may increase lifestyle physical activity and cardiorespiratory fitness in this specific and particularly vulnerable population, which often suffers from both mental and physical health problems. Therefore, this study will examine the impact of a lifestyle physical activity counselling intervention on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers among in-patients diagnosed with MDD compared to controls. Secondary purposes are to examine the acceptability and perceived usefulness of the intervention among these patients, to find out whether the effectiveness of the intervention is moderated by genetic factors, and to compare baseline values with an age- and gender-matched group of healthy controls.

METHODS

The study is designed as a multi-centric two-arm randomized clinical trial including an intervention group and a placebo control group, allocation concealment, single-blinding, and intention-to-treat analysis. Participants (N = 334) will be continuously recruited from four clinics specialized in the treatment of MDD. The intervention builds on a standardized, theory-based, low-cost lifestyle physical activity counselling programme, which was specifically designed for an in-patient rehabilitation setting. The placebo control condition consists of general instructions about health-enhancing physical activity. Data assessments will take place 2-3 weeks after admission to in-patient treatment (baseline), and 6 weeks (post) and 12 months (follow-up) after discharge from in-patient treatment. The primary outcome is objectively assessed physical activity at follow-up.

DISCUSSION

Because regular physical activity has proven to be an important predictor of long-term response and remission in patients with major depression, we believe that our planned study may lay important groundwork by showing how individually tailored lifestyle physical activity counselling can be integrated into given clinical structures. Improving physical activity may have important implications for tackling metabolic and cardiovascular disease and increasing mood and cognitive functioning in this at-risk population, hence limiting the future burden of multiple chronic conditions. Increased physical activity may also reduce the likelihood of future depressive episodes. By moving towards the primary prevention of chronic physical conditions, much can be done to enhance the quality and quantity of life of people with MDD.

TRIAL REGISTRATION

ISRCTN, ISRCTN10469580 . Registered on 3 September 2018.

Modeling physical activity data using L0 -penalized expectile regression

In recent years accelerometers have become widely used to objectively assess physical activity. Usually intensity ranges are assigned to the measured accelerometer counts by simple cut points, disregarding the underlying activity pattern. Under the assumption that physical activity can be seen as distinct sequence of distinguishable activities, the use of hidden Markov models (HMM) has been proposed to improve the modeling of accelerometer data. As further improvement we propose to use expectile regression utilizing a Whittaker smoother with an L₀ -penalty to better capture the intensity levels underlying the observed counts. Different expectile asymmetries beyond the mean allow the distinction of monotonous and more variable activities as expectiles effectively model the complete distribution of the counts. This new approach is investigated in a simulation study, where we simulated 1,000 days of accelerometer data with 1 and 5 s epochs, based on collected labeled data to resemble real-life data as closely as possible. The expectile regression is compared to HMMs and the commonly used cut point method with regard to misclassification rate, number of identified bouts and identified levels as well as the proportion of the estimate being in the range of ± 10 % of the true activity level. In summary, expectile regression utilizing a Whittaker smoother with an L₀ -penalty outperforms HMMs and the cut point method and is hence a promising approach to model accelerometer data.

Theoretical framework and protocol for the evaluation of Strong Through Every Mile (STEM), a structured running program for survivors of intimate partner violence

BACKGROUND

Intimate partner violence can have a devastating impact on victims' psychological and physical health and ability to maintain and preserve interpersonal relationships. The aim of the current study is to empirically test the effectiveness of Strong Through Every Mile (STEM), a 10-week structured running (exercise) program designed to increase psychological, social, and physical well-being among survivors of intimate partner violence. To the authors' knowledge, STEM is the only community-based structured running program designed to improve the quality of life of survivors of intimate partner violence. This paper will describe the STEM program and present the theoretical basis of the program and the program evaluation design.

METHODS

The current study will utilize an interdisciplinary lens to evaluate a community-based intervention aimed at decreasing the negative effects of intimate partner violence on women's lives. The study will use a mixed method approach (qualitative and quantitative), including a pre- and post-test evaluation of the STEM running program. Primary data will be collected using paper and pencil surveys which assess women's psychological, social, and physical well-being prior to participation in the program and following the completion of the program. Qualitative data from focus groups will also be collected and allow for a more rich understanding of the changes that women experience over the course of the program and specific mechanisms underlying these changes.

DISCUSSION

The current study will employ an interdisciplinary lens to examine the extent to which a structured exercise program, specifically running, impacts the psychological, social and physical well-being of women survivors of intimate partner violence. Findings of this study can influence the development and implementation of similar programs for survivors of intimate partner violence and other types of trauma by identifying mechanisms central in achieving positive outcomes for participants.

Health benefits of a physical exercise program for inpatients with mental health; a pilot study

The positive effect of exercise on human health and the relationship between physical activity, health, and wellbeing are well studied and extensively documented in the literature. However, considerably less attention is devoted to the impact of exercise on mental health and wellbeing for people experiencing a mental illness, in general, and in particular for inpatients in the mental health care system. Here, we determine the clinical feasibility and effects of short-term (up to three months) vs long-term (up to six months) group-based exercise program for inpatients with chronic mental health. Changes in psychiatric symptoms, well-being, empathy, and physiological fitness factor (e.g., fasting blood glucose, lipid profile, hemoglobin A1C, and BMI) were monitored before, during and following the physical exercise program. Here, we demonstrated that long-term physical activity improved negative symptoms, but not positive symptoms, while improvement in the severity of the illness as measured by the BPRS questionnaire was found to be independent of the training time. We additionally showed that the empathic ability of patients who exercised for more than three months was significantly improved as compared to the other experimental groups. No significant differences were found in wellbeing, mood, satisfaction, and functioning between exercise groups and the control group. Furthermore, physical activity did not improve any of the physiological parameters that were measured in this study. Together, these data indicate that exercise for at least 3 months seems to improve the overall patient mental state, but not his or her physiological parameters, while improvement in negative symptoms and patient's empathy may occur only after a long-term physical exercise activity.

Device-Measured Desk-Based Occupational Sitting Patterns and Stress (Hair Cortisol and Perceived Stress)

Background: Stress and poor mental health are significant issues in the workplace and are a major cause of absenteeism and reduced productivity. Understanding what might contribute towards employee stress is important for managing mental health in this setting. Physical activity has been shown to be beneficial to stress but less research has addressed the potential negative impact of sedentary behaviour such as sitting. Therefore, the aim of this study was to assess the relationship between device-measured occupational desk-based sitting patterns and stress (hair cortisol levels (HCL), as a marker of chronic stress and self-reported perceived stress (PS)). Methods: Employees were recruited from four workplaces located in Central Scotland with large numbers of desk-based occupations. Seventy-seven participants provided desk-based sitting pattern data (desk-based sitting time/day and desk-based sit-to-stand transitions/day), a hair sample and self-reported perceived stress. HCL were measured using enzyme-linked immunosorbent assay and PS using the Cohen Self-Perceived Stress Scale. Linear regression models were used to test associations between desk-based sitting time/day, desk-based sit-to-stand transitions/day, HCL and PS. Results: There were no associations between any of the desk-based sitting measures and either HCL or PS. Conclusions: Desk-based sitting patterns in the workplace may not be related to stress when using HCL as a biomarker of chronic stress or PS. The relationship between sitting patterns and stress therefore requires further investigation.

Physical exercise and body mass index as correlates of major depressive disorder in community-dwelling adults: Results from the PISMA-ep study

BACKGROUND

Major Depressive Disorder (MDD) is one of the most prevalent and disabling mental disorders. Sedentarism and obesity are recognized risk factors for MDD. Physical exercise has shown beneficial effects on mental health and there is an increasing awareness of its potential as a therapeutic and preventive tool for depression. No epidemiological studies have explored the role of physical activity and obesity as potential correlates of MDD in the Spanish population. The aim of this study was to explore whether MDD was associated with two strongly linked variables: physical exercise and body mass index.

METHODS

The PISMA-ep is a cross-sectional community-based study carried out in Andalusia, southern Spain. Main outcome was current prevalence of MDD, measured through face-to-face interviews using the Mini-International Neuropsychiatric Interview (MINI). Independent variables explored were physical exercise and its intensity, Body Mass Index (BMI), BMI categories (underweight, normal weight, overweight and obesity), hip and waist circumferences, general health status measured with the SF12 questionnaire, and sociodemographic factors.

RESULTS

Physical exercise was inversely associated with MDD, acting as a protective factor. Higher intensity of exercise strengthened this association. Four variables were independently associated with MDD in the multivariate association model: female sex, physical exercise, general health status and BMI.

CONCLUSION

MDD was associated with poorer health status, higher BMI and reduced physical activity. Physical exercise should be considered as a potential intervention for the treatment and prevention of MDD in clinical and public health settings.

The influence of depression status on weekly exercise in children ages 6 to 17 years

Exercise has been found to be an effective treatment for mild to moderate depression. The purpose of this study is to explore the relationship between depression status and weekly exercise in children ages 6 to 17 years stratifying by age and sex using a large nationally representative sample. The study data (n = 65,059) came from the 2011-12 National Survey of Children's Health. Depression categories were current, former, and no history of diagnosed depression. Exercise categories were exercising ≤6 days a week and 7 days a week. Multivariable regression stratified by age and by sex was conducted on the weighted survey data. Among children age 6 to 17, 95.2% were never depressed, 2.1% were formerly depressed, and 2.8% were currently depressed and 28.0% exercised daily. Currently depressed children had 0.75 (95% CI 0.56, 1.00) times and formerly depressed children had 1.09 (95% CI 0.76, 1.57) times the adjusted odds of exercising daily compared to never depressed children. Stratified separately by sex and by age, females and children age 12 to 17 with current depression had 0.63 (95% CI 0.42, 0.94) and 0.48 (95% CI 0.35, 0.66) times the adjusted odds of exercising daily compared to their counterparts with no depression. This study indicates a significant difference in daily exercise habits between currently depressed children age 12 to 17 and females compared to their never depressed counterparts. Healthcare workers should be aware of the possible heightened risk of physical inactivity for depressed female children and children age 12 to 17.

Fitness and Body Mass Index During Adolescence and Disability Later in Life: A Cohort Study

BACKGROUND

Low physical fitness, obesity, and the combination of the two in adolescence may be related to risk for disability in adulthood, but this has rarely been studied.

OBJECTIVE

To examine individual and combined associations of cardiorespiratory fitness and obesity in male adolescents with later receipt of a disability pension due to all and specific causes.

DESIGN

Population-based cohort study.

SETTING

Sweden.

PARTICIPANTS

1 079 128 Swedish adolescents aged 16 to 19 years who were conscripted into the military between 1972 and 1994.

MEASUREMENTS

Cardiorespiratory fitness and body mass index (BMI) were measured at conscription and were related to information on later receipt of a disability pension obtained from the Social Insurance Agency.

RESULTS

Over a median follow-up of 28.3 years, 54 304 men were granted a disability pension. Low cardiorespiratory fitness was strongly associated with later receipt of a disability pension due to all causes (hazard ratio, 3.74 [95% CI, 3.55 to 3.95] for lowest vs. highest fitness decile) and specific causes (psychiatric, musculoskeletal, injuries, nervous system, circulatory, and tumors). Obesity was associated with greater risk for receipt of a disability pension due to all and specific causes, with the greatest risks observed for class II and III obesity. Compared with being unfit, being moderately or highly fit was associated with attenuated risk for receipt of a disability pension across BMI categories.

LIMITATION

The cohort did not include women, had data on smoking and alcohol intake only in a subsample, and lacked repeated measures of exposures and covariates.

CONCLUSION

Low cardiorespiratory fitness, obesity, and the combination of the two were strongly associated with later chronic disability due to a wide range of diseases and causes. Although additional well-designed studies are required, these findings support the importance of high cardiorespiratory fitness and healthy body weight during adolescence to prevent later chronic disease.

PRIMARY FUNDING SOURCE

Karolinska Institutet.

Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis

Although exercise is associated with depression relief, the effects of aerobic exercise (AE) interventions on clinically depressed adult patients have not been clearly supported. The purpose of this meta-analysis was to examine the antidepressant effects of AE versus nonexercise comparators exclusively for depressed adults (18-65 years) recruited through mental health services with a referral or clinical diagnosis of major depression. Eleven e-databases and bibliographies of 19 systematic reviews were searched for relevant randomized controlled clinical trials. A random effects meta-analysis (Hedges' g criterion) was employed for pooling postintervention scores of depression. Heterogeneity and publication bias were examined. Studies were coded considering characteristics of participants and interventions, outcomes and comparisons made, and study design; accordingly, sensitivity and subgroup analyses were calculated. Across 11 eligible trials (13 comparisons) involving 455 patients, AE was delivered on average for 45 min, at moderate intensity, three times/week, for 9.2 weeks and showed a significantly large overall antidepressant effect (g = -0.79, 95% confidence interval = -1.01, -0.57, P < 0.00) with low and nonstatistically significant heterogeneity (I² = 21%). No publication bias was found. Sensitivity analyses revealed large or moderate to large antidepressant effects for AE (I² ≤ 30%) among trials with lower risk of bias, trials with short-term interventions (up to 4 weeks), and trials involving individual preferences for exercise. Subgroup analyses revealed comparable effects for AE across various settings and delivery formats, and in both outpatients and inpatients regardless symptom severity. Notwithstanding the small number of trials reviewed, AE emerged as an effective antidepressant intervention.

Cardio-Respiratory Fitness and Autonomic Function in Patients with Major Depressive Disorder

Patients with major depressive disorder (MDD) have an augmented risk of cardiovascular morbidity and mortality. Although a link between depression and autonomic dysfunction as well as reduced cardio-respiratory fitness (CRF) is well documented, the underlying cause is a matter of debate. Therefore, we studied the interplay between autonomic function, body composition and severity of the disease to disentangle possible physiological factors influencing the assumed lack of CRF in MDD patients. We investigated seventeen patients suffering from MDD and seventeen control subjects matched with respect to age, sex, body-mass-index, and smoking habits. A resting baseline assessment and a cardiopulmonary exercise test including a prolonged recovery period were performed to study autonomic function (i.e., heart rate responses and heart rate variability) during rest, exercise and recovery as well as CRF. Most investigated autonomic indices were significantly different at rest, during exercise as well as during recovery indicating altered autonomic modulation. Nevertheless, none of our participants was classified as chronotropically incompetent. As expected, a reduced CRF (i.e., peak oxygen uptake and peak power output, p < 0.01) was observed in patients compared to controls. In addition, a correlation of baseline heart rate and of heart rate during recovery with the ventilatory threshold 1 (p < 0.05) was found in patients only, indicating a relation to the lack of CRF. Furthermore, we observed a positive correlation of the severity of the disease with the weekly sitting time (p < 0.01) as well as a negative correlation with the activity time in the intensity domain walking (p < 0.001) and with the total score of the International Physical Activity Questionnaire (p < 0.01) for patients. This study shows that patients with MDD have altered autonomic function not only during resting conditions but also during exercise as well as recovery from exercise. Intervention studies are needed to evaluate how the described autonomic alterations can be influenced by increasing CRF due to appropriate exercise training programs.

Depression in Somatic Disorders: Is There a Beneficial Effect of Exercise?

Background: The beneficial effects of exercise training on depressive symptoms are well-established. In the past years, more research attention has been drawn to the specific effects of exercise training on depressive symptoms in somatically ill patients. This reviews aims at providing a comprehensive overview of the current findings and evidence of exercise interventions in somatic disorders to improve depressive symptoms. Methods: We systematically searched PubMed and Cochrane databases and extracted meta-analyses from somatically ill patients that underwent exercise interventions and provided information about the outcome of depressive symptoms. Results: Of the 4123 detected publications, 39 were selected for final analysis. Various diseases were included (breast-cancer, prostate cancer, mixed-cancer, cardiovascular disease, coronary heart disease, hemodialysis, fibromyalgia syndrome, acute leukemia, other hematological malignancies, heart failure, HIV, multiple sclerosis, mixed neurological disorders, Parkinson's disease, stroke, ankylosing spondylitis, traumatic brain injury, lupus erythematodes). Most meta-analyses (33/39) found beneficial effects on depressive symptoms, but quality of the included studies as well as duration, intensity, frequency, and type of exercise varied widely. Conclusion: Exercise training has the potential to improve depressive symptoms in patients with somatic disorders. For specific training recommendations, more high quality studies with structured exercise programs and better comparability are needed.

Sprint Interval Training and Continuous Aerobic Exercise Training Have Similar Effects on Exercise Motivation and Affective Responses to Exercise in Patients With Major Depressive Disorders: A Randomized Controlled Trial

Background: Sprint interval training (SIT) has become increasingly popular and is seen as a promising exercise strategy to increase fitness in healthy people. Nevertheless, some scholars doubt the appropriateness of a SIT training protocol for largely physically inactive populations. SIT might be too arduous, and therefore contribute to feelings of incompetence, failure, and lower self-esteem, which may undermine participants' exercise motivation. Therefore, we examined whether participation in 12 SIT sessions would lead to different changes in self-determined motivation, affective responses to exercise, cardiorespiratory fitness, physical activity, and depressive symptom severity compared to aerobic exercise training (CAT) in a sample of patients with major depressive disorders (MDD). Methods: Two groups of 25 patients (39 women, 11 men) with unipolar depression were randomly assigned to the SIT or CAT condition (M = 36.4 years, SD = 11.3). Data were assessed at baseline and post-intervention (three weekly 35-min sessions of SIT/CAT over a 4-week period). Self-determined exercise motivation was assessed with a 12-item self-rating questionnaire, affective valence was assessed in each session, prior, during, and after the exercise training using the Feeling Scale (FS). Cardiovascular fitness was measured with a maximal bicycle ergometer test, self-perceived fitness with a 1-item rating scale, physical activity with the International Physical Activity Questionnaire (IPAQ-SF), and depressive symptom severity with the Beck Depression Inventory II (BDi-II). Results: The SIT and CAT groups did not differ with regard to their changes in self-determined motivation from baseline to post-intervention. Participants in the SIT and CAT group showed similar (positive) affective responses during and after the training sessions. Cardiorespiratory fitness, self-perceived fitness and depressive symptom severity similarly improved in the SIT and CAT group. Finally, significant increases were observed in self-reported physical activity from baseline to post-intervention. However, these increases were larger in the CAT compared to the SIT group. Conclusion: From a motivational point of view, SIT seems just as suited as CAT in the treatment of patients with MDD. This is a promising finding because according to self-determination theory, it seems advantageous for patients to choose between different exercise therapy regimes, and for their preferences with regard to exercise type and intensity to be considered.

Exercise effects on mood, and its associations with self-regulatory skills, self-efficacy, and eating changes during the year following weight-loss treatment

Maintaining weight loss beyond an initial year of behavioral treatment is of concern, and understanding interrelationships of theory-based psychosocial correlates is minimal. Although exercise is universally suggested, its indirect impacts on long-term nutritional changes are unclear. Data from women with obesity (N= 129), who participated in the treatment groups of two initial trials of a new social cognitive theory-based weight-loss protocol during 2016-2017, were incorporated. The intervention emphasized exercise adherence for two months prior to the next 12 months of biweekly meetings for nutritional change. Effects of exercise-induced changes in mood, and the role of self-regulatory skills in facilitating self-efficacy and improved eating 12-24 months after treatment initiation, were assessed. Change in mood significantly moderated changes in self-regulation for controlled eating by exercise-related self-regulation. During Months 12 to 24, changes in both fruit/vegetable and sweets intake, by self-regulation for eating change, was significantly mediated by change in self-efficacy for controlled eating. Mood change from Months 12 to 24 was significantly associated with change in exercise, with indications that maintaining an equivalent of three days/week had critical value. Findings suggest the importance of bolstering self-regulatory skill usage beyond an initial year of treatment in women.

Effects of an exercise program on the physiological, biological and psychological profiles in patients with mood disorders: a pilot study

Objective: The objective of this study is to assess the impact of an 8-week physical training program on physiological, biological and psychological profiles in individual with mood disorders. Methods: Seven patients participated in the study. Patients were trained twice weekly (75 min/session) for 8 weeks. The training program aimed to improve muscular and cardiorespiratory reserves as well as functional capacity. Bioassays were also measured (lipid profile, blood glucose and cortisol). Depression, sleep quality and body image dissatisfaction were assessed. All measures were administrated at pre/post-intervention. Results: At post-intervention, 13 of the 15 physiological fitness, muscular strength and functional capacity variables improved significantly (p < .05). In addition, change in cortisol levels represented a medium to large effect size (Cohen's d = -0.67) which indicates a clinical reduction of stress-related symptoms. Depression was significantly improved (Cohen's d = -0.47; p = .027). Sleep and body image showed a trend-level improvement. Conclusions: An 8-week periodised training program improved physiological, biological and psychological profiles in patients with mood disorders.

A Twelve-Week Moderate Exercise Programme Improved Symptoms of Depression, Insomnia, and Verbal Learning in Post-Aneurysmal Subarachnoid Haemorrhage Patients: A Comparison with Meningioma Patients and Healthy Controls

OBJECTIVES

Deficits in psychological functioning, cognitive functioning, and sleep are frequently experienced by individuals who have survived aneurysmal subarachnoid haemorrhage (aSAH). Exercise has been shown to improve these domains; to date, it has never been explored in patients following aSAH. The aim of this exploratory study is to compare the effects of an exercise programme in this population with another patient group, and a group of healthy controls.

METHODS

The present study explored the effects of 12 weeks of moderate aerobic exercise training on 15 aSAH patients, 16 meningioma patients, and 17 healthy controls. Data on symptoms of depression, hypochondria, perceived stress, satisfaction with life, verbal learning and memory, and subjective and objective sleep, were gathered at baseline, following intervention, and at 6-month follow-up.

RESULTS

aSAH patients and meningioma patients had decreased symptoms of depression and insomnia at follow-up. While perceived stress decreased in the meningioma group, in aSAH patients it increased. Total learning performance increased in all three groups.

CONCLUSIONS

An exercise programme had a positive effect on symptoms of depression, insomnia, and verbal learning in patients following aSAH. No positive changes in other domains were observed. This may be due to the cautious approach taken with regard to exercise intensity.

Effects of a lifestyle intervention on psychosocial well-being of severe mentally ill residential patients: ELIPS, a cluster randomized controlled pragmatic trial

Large studies investigating the psychosocial effects of lifestyle interventions in patients with a severe mental illness (SMI) are scarce, especially in residential patients. This large, randomized controlled, multicentre pragmatic trial assessed the psychosocial effects of a combined diet-and-exercise lifestyle intervention targeting the obesogenic environment of SMI residential patients. Twenty-nine sheltered and clinical care teams were randomized into intervention (n=15) or control (n=14) arm. Team tailored diet-and-exercise lifestyle plans were set up to change the obesogenic environment into a healthier setting, and team members were trained in supporting patients to make healthier choices. The control group received care-as-usual. The Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Syndrome Scale (PANSS), Health of the Nation Outcome Scales (HoNOS) and the Manchester Short Assessment of Quality of Life (MANSA) were assessed at baseline and after three and twelve months. Data were available for 384 intervention and 386 control patients (48.6±12.5years old, 62.7% males, 73.7% psychotic disorder). Linear mixed model analysis showed no psychosocial improvements in the intervention group compared to care-as-usual; the intervention group showed a slightly reduced quality of life (overall) and a small increase in depressive symptoms (clinical care facilities) and psychotic symptoms (sheltered facilities). This may be due to difficulties with implementation, the intervention not being specifically designed for improvements in mental well-being, or the small change approach, which may take longer to reach an effect. Further research might elucidate what type of lifestyle intervention under what circumstances positively affects psychosocial outcomes in this population.

MODERATE INTENSITY PHYSICAL EXERCISE: PSYCHONEUROIMMUNOLOGICAL ASPECTS

ABSTRACT The literature presents several instances of interaction between the nervous system (NS) and the immune system (IS). These interactions are promoted by several molecules, such as cytokines and hormones, with modulating action for both the NS and IS. In this sense, the two systems may influence each other: changes in behavior may be accompanied by alterations in the IS (e.g., immunosuppression) and immunological disorders, such as infections, may modulate behavior (e.g., anxiety and depression). Considering that chronic stress, in addition to affecting behavior, also modulates the IS and that there is evidence that moderate intensity physical exercise (PE) protects physical and mental health, the objective of this review is to explore the influence of moderate-intensity PE on behavior and immunity. Level of Evidence V; Expert opinion.

Physical exercise and glaucoma: a review on the roles of physical exercise on intraocular pressure control, ocular blood flow regulation, neuroprotection and glaucoma-related mental health

The benefits of physical exercise on health and well-being have been studied in a wide range of systemic and ocular diseases, including glaucoma, a progressive optic neuropathy characterized by accelerated apoptosis of retinal ganglion cells (RGCs). Elevated intraocular pressure (IOP) and insufficient ocular perfusion have been postulated to be the two main theories in glaucoma development and progression. The effects of exercise in these two aspects have been demonstrated by numerous researches. A review in 2009 focusing on these two theories concluded that exercise results in transient IOP reduction but an inconsistent elevation in ocular perfusion. However, the majority of the studies had been conducted in healthy subjects. Over the past decade, technological advancement has brought forth new and more detailed evidence regarding the effects of exercise. Moreover, the neuroprotective effect of exercise by upregulation of neurotrophin and enhancement of mitochondrial function has been a focus of interest. Apart from visual impairment, the mental health issues in patients with glaucoma, which include anxiety and depression, should also be addressed. In this review, we mainly focus on publications from the recent years, so as to provide a comprehensive review on the impact of physical exercise on IOP, ocular perfusion, neuroprotection and mental health in patients with glaucoma.

Cardiorespiratory fitness and response to exercise treatment in depression

BACKGROUND

Exercise improves cardiorespiratory fitness (CRF) and reduces depressive symptoms in people with depression. It is unclear if changes in CRF are a predictor of the antidepressant effect of exercise in people with depression.

AIMS

To investigate whether an increase in CRF is a predictor of depression severity reduction after 12 weeks of exercise (trial registration: DRKS study ID, DRKS00008745).

METHOD

The present study includes participants who took part in vigorous (n = 33), moderate (n = 38) and light (n = 39) intensity exercise and had CRF information (as predicted maximal oxygen uptake, V̇O_2max) collected before and after the intervention. Depression severity was measured with the Montgomery-Åsberg Depression Rating Scale (MADRS). V̇O_2max (L/min) was assessed with the Åstrand-Rhyming submaximal cycle ergometry test. The main analysis was conducted pooling all exercise intensity groups together.

RESULTS

All exercise intensities improved V̇O_2max in people with depression. Regardless of frequency and intensity of exercise, an increase in post-treatment V̇O_2max was significantly associated with reduced depression severity at follow-up (B = -3.52, 95% CI -6.08 to -0.96); adjusting for intensity of exercise, age and body mass index made the association stronger (B = -3.89, 95% CI -6.53 to -1.26). Similarly, increased V̇O_2max was associated with higher odds (odds ratio = 3.73, 95% CI 1.22-11.43) of exercise treatment response (≥50% reduction in MADRS score) at follow-up.

CONCLUSIONS

Our data suggest that improvements in V̇O_2max predict a greater reduction in depression severity among individuals who were clinically depressed. This finding indicates that improvements in V̇O_2max may be a marker for the underpinning biological pathways for the antidepressant effect of exercise.

DECLARATION OF INTEREST

None.

Physical Activity Preferences and Attitudes of Individuals With Substance Use Disorders: A Review of the Literature

Substance use disorders (SUDs) are prevalent in the United States and costly to society. SUDs contribute significantly to decreased quality of life and overdose deaths. Physical activity (PA) interventions may be one efficacious method to improve recovery and long-term abstinence from substance use; although PA interventions have resulted in positive physical and psychological outcomes, their adherence and attrition rates have been problematic. To address lack of adherence and high attrition rates, it is important to understand the preferences and attitudes for PA among patients in SUD treatment. We, therefore, conducted a literature review to examine preferences and attitudes for PA among adults with SUDs. Five articles met inclusion and exclusion criteria. The findings from this small sample of studies suggest that adults with SUDs are interested in PA. Walking, strength training, and cycling were the activities preferred most frequently. Participants said that they would like to engage in these activities either alone or with small groups and would prefer their exercise options to be located at facilities they already frequented, such as treatment clinics. Nurses are well positioned to assess patient preferences and attitudes and to enhance recovery efforts in this population. Further exploration of this population's unique preferences and attitudes regarding PA may lay the groundwork for efficacious PA interventions with improved adherence and attrition rates, which may lead to improved recovery outcomes.

Does ceasing exercise induce depressive symptoms? A systematic review of experimental trials including immunological and neurogenic markers

BACKGROUND

Regular exercise in adults improves depressive symptoms (DS) and major depressive disorder (MDD), however the clinical effects of ceasing exercise are largely unknown.

METHODS

Seven databases were searched from inception to December 2017. Eligibility criteria included English language studies investigating the effects of ceasing exercise on DS or MDD in regularly active adults with or without prior DS or MDD. Blood based markers related to exercise cessation (EC) were assessed, if recorded. Studies investigating exercise follow-up periods were excluded.

RESULTS

No studies investigated EC in MDD. Six studies including two RCTS and three studies investigating neurogenic and immune biological markers associated with DS met inclusion criteria (152 healthy adults, females n = 50/32.89%). Compared to baseline, EC increased DS after three days, one week, and two weeks. Female participants had significantly more DS than male participants. Following EC, no changes in brain derived neurotrophic factor (BDNF) or tumour necrosis factor alpha (TNF) were evident, however C-reactive protein (CRP) at week one and interleukin 6 (IL6) at week two were reduced.

LIMITATIONS

Quality concerns including risks of attrition and reporting bias limit our confidence in these results.

CONCLUSIONS

Ceasing regular exercise increases DS in healthy adults, with greater DS in females than males. Contrary to the cytokine/inflammatory hypothesis of depression, DS were associated with reduced CRP and IL6 and without increased TNF. High quality trials are needed to extend this field of research in both healthy and MDD populations.

The 2017 Dutch Physical Activity Guidelines

Background

The objective of this study was to derive evidence-based physical activity guidelines for the general Dutch population.

Methods

Two systematic reviews were conducted of English language meta-analyses in PubMed summarizing separately randomized controlled trials and prospective cohort studies on the relation between physical activity and sedentary behaviour on the one hand and the risk of all-cause mortality and incidence of 15 major chronic diseases and conditions on the other hand. Other outcome measures were risk factors for cardiovascular disease and type 2 diabetes, physical functioning, and fitness. On the basis of these reviews, an expert committee derived physical activity guidelines. In deriving the guidelines, the committee first selected only experimental and observational prospective findings with a strong level of evidence and then integrated both lines of evidence.

Results

The evidence found for beneficial effects on a large number of the outcome measures was sufficiently strong to draw up guidelines to increase physical activity and reduce sedentary behaviour, respectively. At the same time, the current evidence did not provide a sufficient basis for quantifying how much physical activity is minimally needed to achieve beneficial health effects, or at what amount sedentary behaviour becomes detrimental. A general tenet was that at every level of current activity, further increases in physical activity provide additional health benefits, with relatively larger effects among those who are currently not active or active only at light intensity. Three specific guidelines on (1) moderate- and vigorous-intensity physical activity, (2) bone- and muscle-strengthening activities, and (3) sedentary behaviour were formulated separately for adults and children.

Conclusions

There is an unabated need for evidence-based physical activity guidelines that can guide public health policies. Research in which physical activity is measured both objectively (quantity) and subjectively (type and quality) is needed to provide better estimates of the type and actual amount of physical activity required for health.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0661-9) contains supplementary material, which is available to authorized users.

A Complier Average Causal Effect Analysis of the Stimulant Reduction Intervention using Dosed Exercise Study

Objective

Exercise is a promising treatment for substance use disorders, yet an intention-to-treat analysis of a large, multi-site study found no reduction in stimulant use for exercise versus health education. Exercise adherence was sub-optimal; therefore, secondary post-hoc complier average causal effects (CACE) analysis was conducted to determine the potential effectiveness of adequately dosed exercise.

Method

The STimulant use Reduction Intervention using Dosed Exercise study was a randomized controlled trial comparing a 12 kcal/kg/week (KKW) exercise dose versus a health education control conducted at nine residential substance use treatment settings across the U.S. that are affiliated with the National Drug Abuse Treatment Clinical Trials Network. Participants were sedentary but medically approved for exercise, used stimulants within 30 days prior to study entry, and received a DSM-IV stimulant abuse or dependence diagnosis within the past year. A CACE analysis adjusted to include only participants with a minimum threshold of adherence (at least 8.3 KKW) and using a negative-binomial hurdle model focused on 218 participants who were 36.2% female, mean age 39.4 years (SD = 11.1), and averaged 13.0 (SD = 9.2) stimulant use days in the 30 days before residential treatment. The outcome was days of stimulant use as assessed by the self-reported TimeLine Follow Back and urine drug screen results.

Results

The CACE-adjusted analysis found a significantly lower probability of relapse to stimulant use in the exercise group versus the health education group (41.0% vs. 55.7%, p < .01) and significantly lower days of stimulant use among those who relapsed (5.0 days vs. 9.9 days, p < .01).

Conclusions

The CACE adjustment revealed significant, positive effects for exercise. Further research is warranted to develop strategies for exercise adherence that can ensure achievement of an exercise dose sufficient to produce a significant treatment effect.

What types of physical activities are effective in developing muscle and bone strength and balance?

The need to be fit, strong, fast and agile has been an evolutionary requirement since early history. In this paper we identify the effectiveness of different types of physical activity on muscle, bone and balance outcomes, and what types of physical activity contribute to the development and maintenance of these outcomes. We undertook a purposive search of PubMed, international evidence reviews of physical activity, and asked international experts to identify review level relevant literature on the effectiveness of muscle, bone and balance training and physical activity on health outcomes. We found consistent review level evidence that strength/resistance training as a single intervention or in combination with other activities, two/three occasions per week, were effective for muscular strength, with higher intensities of training producing greater gains. We found consistent review level evidence that strength training as a single intervention or in combination with high impact loading activities taken at least 3 times per week were effective for bone health. Physical activities with a high challenge to balance done in standing three times per week were beneficial for balance training and falls reduction. The current UK 2011 Chief Medical Officer's physical activity guidelines remain consistent with the most up to date review level evidence for muscle and balance health.

The effectiveness of physical exercise as an intervention to reduce depressive symptoms following traumatic brain injury: A meta-analysis and systematic review

Alongside the obvious health benefits, physical exercise has been shown to have a modest anti-depressant effect for people in the general population. To the authors' knowledge, there are no current literature reviews or meta-analyses available exploring this effect for people with a traumatic brain injury (TBI). A systematic review of intervention studies utilising physical exercise and mood outcome measures for a TBI population was performed in November 2016. Baseline and outcome data were extracted for the nine studies which met the inclusion criteria. Effect sizes were calculated for the three controlled trials and six uncontrolled trials and entered into the meta-analysis. Consistent with research in non-brain injury populations, the current meta-analysis identified a small to medium effect size of physical exercise on reducing depressive symptoms in people with a TBI. This would support further rigorous trials to provide additional evidence for the efficacy of physical exercise interventions for people with TBI. Limitations of the current meta-analysis and clinical implications are discussed.

Effects of 5-aminolevulinic acid supplementation on home-based walking training achievement in middle-aged depressive women: randomized, double-blind, crossover pilot study

Depressive patients often experience difficulty in performing exercise due to physical and psychological barriers. We examined the effects of 5-aminolevulinic acid (ALA) with sodium ferrous citrate (SFC) supplementation during home-based walking training in middle-aged depressive women. Nine outpatients [53 ± 8 (SD) yr] with major depressive disorder participated in the pilot study with randomized, placebo-controlled, double-blind crossover design. They underwent two trials for 7 days, each performing interval walking training (IWT) with ALA + SFC (ALA + SFC) or placebo supplement intake (PLC) intermittently with >a 10-day washout period. For the first 6 days of each trial, exercise intensity for IWT was measured by accelerometry. Before and after each trial, subjects underwent a graded cycling test, and lactate concentration in plasma ([Lac-]p), oxygen consumption rate ([Formula: see text]), and carbon dioxide production rate ([Formula: see text]) were measured with depression severity by the Montgomery-Åsberg Depression Rating Scale (MADRS). We found that the increases in [Lac-]p, [Formula: see text] and [Formula: see text] during the test were attenuated only in ALA + SFC ([before vs. after] × workload; all, P < 0.01), accompanied by increased training days, impulse, and time at fast walking during IWT (all, P < 0.05) with decreased MADRS-score (P = 0.001). Thus, ALA + SFC supplementation increased IWT achievement to improve depressive symptoms in middle-aged women.

Residual Symptoms After Treatment for Depression in Patients With Coronary Heart Disease

OBJECTIVE

Depression is associated with an increased risk of mortality in patients with coronary heart disease (CHD). The risk may be reduced in patients who remit with adequate treatment, but few patients achieve complete remission. The purpose of this study was to identify the symptoms that persist despite aggressive treatment for depression in patients with CHD.

METHODS

One hundred twenty-five patients with stable CHD who met the DSM-IV criteria for a moderate-to-severe major depressive episode completed treatment with cognitive behavior therapy, either alone or combined with an antidepressant, for up to 16 weeks. Depression symptoms were assessed at baseline and after 16 weeks of treatment.

RESULTS

The M (SD) Beck Depression Inventory scores were 30.0 (8.6) at baseline and 8.3 (7.5) at 16 weeks. Seventy seven (61%) of the participants who completed treatment met remission criteria (Hamilton Rating Scale for Depression ≤7) at 16 weeks. Loss of energy and fatigue were the most common posttreatment symptoms both in remitters (n = 44, 57%; n = 34, 44.2%) and nonremitters (n = 42, 87.5%; n = 35, 72.9%). These symptoms were not predicted by baseline depression severity, anxiety, demographic, or medical variables including inflammatory markers or cardiac functioning or by medical events during depression treatment.

CONCLUSIONS

Fatigue and loss of energy often persist in patients with CHD even after otherwise successful treatment for major depression. These residual symptoms may increase the risks of relapse and mortality. Development of effective interventions for these persistent symptoms is a priority for future research.

Treating depression with physical activity in adolescents and young adults: a systematic review and meta-analysis of randomised controlled trials

We aimed to establish the treatment effect of physical activity for depression in young people through meta-analysis. Four databases were searched to September 2016 for randomised controlled trials of physical activity interventions for adolescents and young adults, 12-25 years, experiencing a diagnosis or threshold symptoms of depression. Random-effects meta-analysis was used to estimate the standardised mean difference (SMD) between physical activity and control conditions. Subgroup analysis and meta-regression investigated potential treatment effect modifiers. Acceptability was estimated using dropout. Trials were assessed against risk of bias domains and overall quality of evidence was assessed using GRADE criteria. Seventeen trials were eligible and 16 provided data from 771 participants showing a large effect of physical activity on depression symptoms compared to controls (SMD = -0.82, 95% CI = -1.02 to -0.61, p < 0.05, I2 = 38%). The effect remained robust in trials with clinical samples (k = 5, SMD = -0.72, 95% CI = -1.15 to -0.30), and in trials using attention/activity placebo controls (k = 7, SMD = -0.82, 95% CI = -1.05 to -0.59). Dropout was 11% across physical activity arms and equivalent in controls (k = 12, RD = -0.01, 95% CI = -0.04 to 0.03, p = 0.70). However, the quality of RCT-level evidence contributing to the primary analysis was downgraded two levels to LOW (trial-level risk of bias, suspected publication bias), suggesting uncertainty in the size of effect and caution in its interpretation. While physical activity appears to be a promising and acceptable intervention for adolescents and young adults experiencing depression, robust clinical effectiveness trials that minimise risk of bias are required to increase confidence in the current finding. The specific intervention characteristics required to improve depression remain unclear, however best candidates given current evidence may include, but are not limited to, supervised, aerobic-based activity of moderate-to-vigorous intensity, engaged in multiple times per week over eight or more weeks. Further research is needed. (Registration: PROSPERO-CRD 42015024388).

On the Run for Hippocampal Plasticity

Accumulating research in rodents and humans indicates that exercise benefits brain function and may prevent or delay onset of neurodegenerative conditions. In particular, exercise modifies the structure and function of the hippocampus, a brain area important for learning and memory. This review addresses the central and peripheral mechanisms underlying the beneficial effects of exercise on the hippocampus. We focus on running-induced changes in adult hippocampal neurogenesis, neural circuitry, neurotrophins, synaptic plasticity, neurotransmitters, and vasculature. The role of peripheral factors in hippocampal plasticity is also highlighted. We discuss recent evidence that systemic factors released from peripheral organs such as muscle (myokines), liver (hepatokines), and adipose tissue (adipokines) during exercise contribute to hippocampal neurotrophin and neurogenesis levels, and memory function. A comprehensive understanding of the body-brain axis is needed to elucidate how exercise improves hippocampal plasticity and cognition.

Impact of physical exercise in cancer survivors during and after antineoplastic treatments

Cancer patients experience symptoms and adverse effects of treatments that may last even after the end of treatments. Exercise is a safe, non-pharmacological and cost-effective therapy that can provide several health benefits in cancer patient and survivors, reducing cancer symptoms and cancer treatment side effects. The purpose of this review is to describe how the physical exercise is capable to reduce cancer symptoms and cancer treatment side effects. We realized a pragmatic classification of symptoms, dividing them into physical, psychological and psycho-physical aspects. For each symptom we discuss causes, therapies, we analyse the effects of physical exercise and we summarize the most effective type of exercise to reduce the symptoms. This review also points out what are the difficulties that patients and survivors face during the practice of physical activity and provides some solutions to overcome these barriers. Related to each specific cancer, it emerges that type, frequency and intensity of physical exercise could be prescribed and supervised as a therapeutic program, like it occurs for the type, dose and duration of a drug treatment.

Tobacco use does not influence the response to non-pharmacologic depression treatment: A secondary analysis of the Regassa randomized controlled trial

Behavioural interventions show promising results among patients with mild- to moderate depression. However, whether tobacco use moderates the effects of these interventions is not known. In the present study, we examined whether patients suffering from mild-to-moderate depression differed in their response to prescribed physical exercise or internet-based cognitive behavioural therapy (ICBT) according to their current tobacco use. We conducted a secondary analysis of data from 740 participants in a multicentre randomised controlled trial comparing physical exercise, internet-based cognitive behavioural therapy and treatment as usual (Regassa study). Information on current daily tobacco use was self-reported at baseline. Linear and logistic regression were used to examine the treatments' effect (reduction in depression score) in the subgroups of tobacco users (n=154) and non-users (n=586). We found that baseline tobacco use did not significantly moderate the association between treatment type and post-treatment depression severity. Both interventions (exercise and ICBT) resulted in a reduction of depression scores that was similar among non-users and users of tobacco, albeit formally statistically significant only among non-users. Physical exercise on prescription and ICBT can be used in the clinical management of depressed patients, with similar prognostic advantage among tobacco users and non-users.

The Effectiveness of a Stress Reduction and Burnout Prevention Program

BACKGROUND

Chronic psychological distress appears to have increased in recent years, mainly among the working population. The data available indicate that mental and behavioral disorders, including burnout syndrome, represent not only a personal problem for those afflicted, but also a serious public health issue. This study aimed at evaluating the effects of an outpatient burnout prevention program in a mono-center health resort setting.

METHODS

Adults experiencing an above-average level of stress and thus being at an increased risk of burnout were randomized either to the intervention group (IG) or the waiting control group (WG). The 3-week program included stress management intervention, relaxation, physical exercise and moor applications. The primary outcome was change in perceived stress (PSQ) at 6 months post-intervention. Secondary outcomes included burnout symptoms, well-being, health status, psychological symptoms, back pain, and number of sick days. Participants were examined at baseline, post-intervention (3 weeks) and after 1, 3 and 6 months.

RESULTS

Data from 88 adults (IG=43; WG=45) were available for (per protocol) analysis (mean age: 50.85; 76.1% female). Participants in the IG experienced significant immediate improvement in all outcome measures, which declined somewhat during the first three months post-intervention and then remained stable for at least another three months. Those in the WG did not experience substantial change across time. For the 109 randomized persons, results for PSQ were confirmed in an intention-to-treat analysis with missing values replaced by last observation carried forward (between-group ANCOVA for PSQScore at 6 months, parameter estimator for the group: -20.57; 95% CI: [-26.09; -15.04]). Large effect sizes (Cohen's d for PSQ: 1.09-1.72) indicate the superiority of the intervention.

CONCLUSION

The program proved to be effective in reducing perceived stress, emotional exhaustion and other targets. Future research should examine the long-term impact of the program and the effect of occasional refresher training.

Metabolic/inflammatory/vascular comorbidity in psychiatric disorders; soluble epoxide hydrolase (sEH) as a possible new target

The common and severe psychiatric disorders, including major depressive disorder (MDD) and bipolar disorder (BD), are associated with inflammation, oxidative stress and changes in peripheral and brain lipid metabolism. Those pathways are implicated in the premature development of vascular and metabolic comorbidities, which account for considerable morbidity and mortality, including increased dementia risk. During endoplasmic reticulum stress, the soluble epoxide hydrolase (sEH) enzyme converts anti-inflammatory fatty acid epoxides generated by cytochrome p450 enzymes into their corresponding and generally less anti-inflammatory, or even pro-inflammatory, diols, slowing the resolution of inflammation. The sEH enzyme and its oxylipin products are elevated post-mortem in MDD, BD and schizophrenia. Preliminary clinical data suggest that oxylipins increase with symptoms in seasonal MDD and anorexia nervosa, requiring confirmation in larger studies and other cohorts. In rats, a soluble sEH inhibitor mitigated the development of depressive-like behaviors. We discuss sEH inhibitors under development for cardiovascular diseases, post-ischemic brain injury, neuropathic pain and diabetes, suggesting new possibilities to address the mood and cognitive symptoms of psychiatric disorders, and their most common comorbidities.

Moderating Effects of Exercise Duration and Intensity in Neuromuscular vs. Endurance Exercise Interventions for the Treatment of Depression: A Meta-Analytical Review

Background: Exercise training is a beneficial treatment strategy for depression. Previous meta-analytical reviews mainly examined the effect of aerobic exercise on depressive symptoms neglecting comparisons with neuromuscular training and meta-regression considering relevant exercise training prescriptors such as exercise duration, intensity, number of exercise sessions (volume) and frequency. Methods: A structured literature search was conducted in biomedical and psychological databases and study selection was conducted following the PICOS approach. (Randomized) controlled trials that compared supervised neuromuscular or endurance exercise interventions with an inactive control group (CON) in clinically depressed in- or out-patients over 18 years were included. Eligibility and study quality were evaluated by two independent researchers. Standardized mean differences (SMD) for the reduction of depressive symptoms, measured with different evaluation scales (e.g., BDI, HAM-D, PHQ-9, HRSD, MADRS, GDS) were calculated with the adjusted Hedges'g equation as main outcome for the comparison of endurance and neuromuscular exercise interventions vs. CON. Statistical analyses were conducted using a random effects inverse-variance model. Multivariate meta-regression analysis was performed in order to examine the modulating effects of exercise training prescriptors. Results: Twenty seven trials with 1,452 clinically depressed adults were included. 20 out of 27 included trials reached a PEDro score of at least 6, representing high-quality. Irrespective of the exercise mode and study quality, large effects in favor of exercise compared to the control condition were found. Compared to CON, sensitivity analyses revealed a moderate to large effect in favor of endurance exercise [SMD: -0.79 (90% CI: -1.10, -0.48); p < 0.00001, I² = 84%] and a large effect size in favor of neuromuscular exercise [SMD: -1.14 (90 CI: -1.50, -0.78); p < 0.00001, I² = 80%]. These effects decreased to moderate for endurance and remained large for neuromuscular trials when considering studies of high quality, indicating a significant difference (p = 0.04). Multivariate meta- regression revealed that exercise duration in endurance trials and exercise intensity in neuromuscular trials had a significantly moderating effect. Conclusions: Strong neuromuscular exercise interventions can be slightly more effective than endurance exercise interventions. Interestingly, exercise duration and exercise intensity moderated the effect size meaningfully. This result might be used on exercise in depression to increase efficacy.

Psychiatric In-Patients Are More Likely to Meet Recommended Levels of Health-Enhancing Physical Activity If They Engage in Exercise and Sport Therapy Programs

Background: People with mental disorders engage in sedentary behaviors more often than their healthy counterparts. In Switzerland, nearly all psychiatric hospitals offer structured exercise and sport therapy as part of their standard therapeutic treatment. However, little is known about the degree to which psychiatric patients make use of these treatment offers. The aim of this study is to examine, in a sample of psychiatric in-patients (a) how many participate in the structured exercise and sport therapy programs offered by the clinic, (b) how many engage in exercise and sport activities on an individual basis, and (c) how many meet recommended levels of health-enhancing physical activity during their stay at the clinic. Furthermore, we examine whether those who engage in exercise and sport activities are more likely to meet internationally accepted physical activity recommendations. Methods: 107 psychiatric in-patients (49% women, M_age = 39.9 years) were recruited at three psychiatric clinics in the German-speaking part of Switzerland. All participants were engaged in treatment and received usual care. Based on accelerometer data, participants were classified as either meeting or not meeting physical activity recommendations (≥150 min of moderate-to-vigorous physical activity per week). Participation in structured and individually performed exercise and sport activities was assessed with the Simple Physical Activity Questionnaire. Results: In total, 57% of all patients met physical activity recommendations. 55% participated in structured exercise and sport therapy activities, whereas only 22% of all patients engaged in exercise and sport activities independently. Psychiatric patients were significantly more likely to meet recommended levels of health-enhancing physical activity if they engaged in at least 60 min per week of structured exercise and sport therapy or in at least 30 min of individually performed exercise and sport activity. Conclusions: Given that prolonged immobilization and sedentary behavior have harmful effects on patients' physical and mental well-being, promoting exercise and sport activities is an important endeavor in psychiatric care. Clinics currently succeed in involving between 50 and 60% of all patients in sufficient physical activity. While this is encouraging, more systematic efforts are needed to ensure that all patients get enough physical activity.

Exercise Predicts Long-Term Weight Loss in Women With Class 1 and Class 2 Obesity Through Effects on Emotional Eating and its Correlates

Background: The relationship between exercise and long-term weight loss is definitive. However, in deconditioned individuals, the basis of that relationship beyond minimal energy expenditures is unclear. Effects emanating from exercise’s proposed association with changes in emotional eating and its psychosocial correlates were tested. Methods: Women with class 1 (n = 67) and class 2 (n = 53) obesity, participating in a new community-based weight-loss treatment based on tenets of social cognitive theory, were assessed at baseline and Months 3, 6, 12, and 24 on weight and measures of exercise outputs, emotional eating, eating self-regulation, and negative mood. An exercise-support component was provided for 2 months prior to group nutrition-change sessions. Results: Improvements from baseline were significant on all measures but did not significantly differ by group. Although not for the initial 3 months, changes in exercise significantly predicted weight changes over 6, 12, and 24 months from baseline. However, only 26%–31% of the lost weight was directly attributable to exercise-related energy expenditures. Changes in emotional eating significantly mediated the exercise–weight-loss relationship, and changes in self-regulation and mood significantly mediated the exercise–emotional eating relationship. Conclusions: Findings supported exercise’s role in long-term weight loss primarily through psychosocial factors.

Depression in people with type 2 diabetes: current perspectives

Type 2 diabetes mellitus (T2DM) is associated with depressive symptoms, and comorbid depression in those with T2DM has been associated with adverse clinical profiles. Recognizing and addressing psychological symptoms remain significant clinical challenges in T2DM. Possible mediators of the reciprocal relationship between T2DM and depression may include physical activity levels, effectiveness of self-management, distress associated with a new T2DM diagnosis, and frailty associated with advanced diabetes duration. The latter considerations contribute to a "J-shaped" trajectory from the time of diagnosis. There remain significant challenges to screening for clinical risks associated with psychological symptoms in T2DM; poorer outcomes may be associated with major depressive episodes, isolated (eg, anhedonic), or subsyndromal depressive symptoms, depressive-like symptoms more specific to T2DM (eg, diabetes-related distress), apathy or fatigue. In this review, we discuss current perspectives on depression in the context of T2DM with implications for screening and management of these highly comorbid conditions.

Leisure-time physical inactivity and psychological distress in female-dominated occupations in Lithuania

Poor mental health, manifesting as psychological distress, has become a leading problem recently; therefore, determining associated factors is important, especially in female-dominated occupations, as women are more prone to psychological distress than men, in part due to demands of both professional and domestic tasks. The objective of the present study was to investigate associations between leisure-time physical inactivity and psychological distress, accounting for the possible relation of psychosocial factors at work (job demands, job control, social support at work, workplace bullying) and life events in representative samples of family physicians, internal medicine department nurses and secondary-school teachers in Lithuania. In total, 323 family physicians, 748 internal medicine department nurses and 517 secondary-school teachers were interviewed during 2012-2014 in Lithuania. Godin leisure-time exercise, Goldberg General Health, Job content, and Negative acts questionnaires were administered. Logistic regression was used. A high proportion of family physicians, nurses and teachers were physically inactive during leisure. Leisure-time physical inactivity was strongly associated with psychological distress, adjusting for age, workplace bullying, job demands, job control, social support at work and traumatic life events in all three female-dominated occupations. Efforts to increase leisure-time physical activity level in medical occupations could be beneficial.

Ease of walking associates with greater free-living physical activity and reduced depressive symptomology in breast cancer survivors: pilot randomized trial

PURPOSE

We hypothesized exercise training-induced improvements in ease of walking would associate with favorable changes in objectively measured physical activity (PA) and self-reported depressive symptoms following a PA behavior-change intervention in non-metastatic breast cancer survivors (BCS).

METHODS

Twenty-seven BCS received random assignment to an intervention (INT) or control group (CON). INT included counseling/group discussions coupled with supervised exercise tapered to unsupervised exercise. PA, depressive symptoms, and ease of walking were evaluated pre-/post-intervention using 10-day accelerometry, HADS depression subscale, and indirect calorimetry during a standardized treadmill test, respectively. PA composite score was calculated by converting weekly minutes of moderate-to-vigorous PA and average steps/day to z-scores then dividing the sum by 2. Cardiac efficiency was determined by dividing steady-state oxygen uptake by heart rate to evaluate the volume of oxygen consumed per heartbeat.

RESULTS

ANCOVA revealed a significant time by group interaction showing the INT group exhibited greater positive changes in the PA composite compared to the CON (INT, + 0.14 ± 0.66 au vs. CON, - 0.48 ± 0.49 au; p = 0.019; η _p² = 0.21). Changes occurring from baseline to follow-up, among all participants, revealed improved ease of walking (less oxygen uptake) associated with increased PA composite (r = - 0.52; p = 0.010) and lower depressive symptomology (r = 0.50; p = 0.012) adjusted for age, race, and months since cancer diagnosis. Increased cardiac efficiency during the standardized treadmill test also associated with less daily sedentary time (r = - 0.52; p = 0.021).

CONCLUSIONS

These data support the assertion that reducing the physiological difficulty of walking may contribute to greater engagement in free-living PA, less sedentary time, and decreased psychosocial distress among BCS.

Prediction of treatment outcomes to exercise in patients with nonremitted major depressive disorder

BACKGROUND

Only one-third of patients with major depressive disorder (MDD) achieve remission with initial treatment. Consequently, current clinical practice relies on a "trial-and-error" approach to identify an effective treatment for each patient. The purpose of this report was to determine whether we could identify a set of clinical and biological parameters with potential clinical utility for prescription of exercise for treatment of MDD in a secondary analysis of the Treatment with Exercise Augmentation in Depression (TREAD) trial.

METHODS

Participants with nonremitted MDD were randomized to one of two exercise doses for 12 weeks. Participants were categorized as "remitters" (≤12 on the IDS-C), nonresponders (<30% drop in IDS-C), or neither. The least absolute shrinkage and selection operator (LASSO) and random forests were used to evaluate 30 variables as predictors of both remission and nonresponse. Predictors were used to model treatment outcomes using logistic regression.

RESULTS

Of the 122 participants, 36 were categorized as remitters (29.5%), 56 as nonresponders (45.9%), and 30 as neither (24.6%). Predictors of remission were higher levels of brain-derived neurotrophic factor (BDNF) and IL-1B, greater depressive symptom severity, and higher postexercise positive affect. Predictors of treatment nonresponse were low cardiorespiratory fitness, lower levels of IL-6 and BDNF, and lower postexercise positive affect. Models including these predictors resulted in predictive values greater than 70% (true predicted remitters/all predicted remitters) with specificities greater than 25% (true predicted remitters/all remitters).

CONCLUSIONS

Results indicate feasibility in identifying patients who will either remit or not respond to exercise as a treatment for MDD utilizing a clinical decision model that incorporates multiple patient characteristics.

Postpartum Mothers' Leisure-Time Exercise Behavior is Linked to Positive Emotion During Partner Discussions

PURPOSE

Marital dissatisfaction and conflict often increase for couples after the birth of a child and are evident in fewer positive family interactions and more negative family interactions. Because exercise is known to increase positive emotions and decrease negative emotions, the current study examined the extent to which higher levels of mothers' exercise during the postpartum period were related to more positive and fewer negative emotion-expressive behaviors with their infants' fathers.

METHOD

Mothers' (N = 46; M = 8 months postpartum) positive and negative expressive behaviors were coded during couples' discussions of current conflict and positive family experiences. Mothers self-reported their leisure-time exercise behavior.

RESULTS

First-time mothers and mothers with higher levels of leisure-time exercise behavior displayed higher levels of positive expressive behaviors during couples' discussions.

CONCLUSIONS

Exercise may be associated with increased positive emotion and, in turn, can have great potential to improve family relationships during the postpartum period when marital stress normatively increases, particularly for mothers with more than 1 child. Future longitudinal studies are needed to understand exercise patterns across the postpartum period to identify the most effective timing and optimal level of exercise that lead to more positive expressive behaviors.