Physical activity and mental health: the association between exercise and mood

Glycemic Control in Type 1 Diabetes Mellitus During COVID-19 Quarantine and the Role of In-Home Physical Activity

Background: To limit the spread of coronavirus disease 2019 (COVID-19), governments have ordered a series of restrictions that may affect glycemic control in individuals with type 1 diabetes mellitus (T1DM), since physical activity (PA) was not allowed outside home. Methods: We retrospectively evaluated glycemic control of individuals with T1DM using hybrid closed loop (HCL) system in the period before the SARS-CoV-2 outbreak in Italy (February 10-23, 2020-Time 1), when movements were only reduced (February 24-March 8, 2020-Time 2) and during complete lockdown (March 9-22, 2020-Time 3). Information about regular PA (at least 3 h per week) prior and during the quarantine was collected. Results: The study included 13 individuals with a median age of 14.2 years and a good glycemic control at baseline (glucose management indicator of 7%, time in range [TIR] of 68%, time below range [TBR] of 2%). All individuals continued to show good glycemic control throughout the study period. There was an increase in TIR during the study period (+3%) and TIR was significantly higher during Time 3 (72%) than during Time 2 (66%). TBR was significantly lower during Time 3 (1%) both compared with Time 1 and Time 2 (2%). A meaningful variance in TIR at Time 3 between individuals who performed or not PA during quarantine and a significant increase in TIR between Time 2 and Time 3 in individuals both doing PA at baseline and during quarantine was found. At logistic regression, only the presence of PA during quarantine significantly predicted a TIR >70%. Conclusions: Glycemic control of T1DM in adolescents using HCL system did not worsen during the restrictions due to COVID-19 pandemics and further improved in those who continued PA during the quarantine. Maintaining regular PA in a safe home environment is an essential strategy for young individuals with T1DM during the COVID-19 crisis.

Longitudinal associations between physical activity, anxiety, and depression in adults with long-term physical disabilities

OBJECTIVE

To evaluate the longitudinal associations between self-reported physical activity and anxiety and depression symptom severity in adults with long-term physical disabilities.

METHOD

A secondary analysis of data from a United States-based longitudinal survey study of community-dwelling adults with 1 of 4 potential long-term physical disabilities (multiple sclerosis, muscular dystrophy, spinal cord injury, postpoliomyelitis syndrome). The first time point (T1) for the current study was completed by 1,594 participants. The second survey (T2) was sent 1 year later, and the third (T3) was sent 3 years later; each were completed by 1,380 and 1,218 participants, respectively. At each time point, participants completed a measure of physical activity (Godin Leisure Time Exercise Questionnaire) and Patient-Reported Outcomes Measurement System short forms evaluating depression and anxiety severity.

RESULTS

Mixed growth curve models showed greater quantities of physical activity were associated with decreases in both depression (χ2(2) = 84.01, p < .001) and anxiety (χ2(2) = 21.66, p < .001) symptom severity over the 4-year period. However, while greater quantities of moderate (anxiety z = -2.24, p < .05; depression z = -5.48, p < .001) and strenuous (anxiety z = -2.59, p < .05; depression z = -3.90, p < .001) physical activity were significantly associated with decreases in negative affect, mild physical activity was not.

CONCLUSION

The current study provides evidence that physical activity is longitudinally associated with anxious and depressive symptoms in adults with long-term physical disabilities. Future research should examine the quantities and intensities of physical activity necessary to impart psychological benefits. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Study on the Impact of Residential Outdoor Environments on Mood in the Elderly in Guangzhou, China

Understanding the relationship between mood and the environment among the elderly is important for the healthy aging agenda. This study aimed to investigate the relationship between residential outdoor environments of different qualities and mood in the elderly. Nine residential neighborhoods across three different quality levels of the outdoor environment in Guangzhou, China, were surveyed. Measures included demographic characteristics, assessment of the residential outdoor environment, and mood status of the elderly. We constructed a group of multiple regression models to investigate influencing environmental factors of participants’ mood. Results revealed that the environmental factors influencing mood in the elderly are different across the three types of residential outdoor environments: function and cleanliness of the site showed a significant correlation with mood in high-quality residences, while pavement was significantly correlated with mood in medium-quality residences. In contrast, transparency, enclosure, greenness, temperature, and humidity were significantly correlated with mood in poor-quality residences. To promote mental health in the elderly, we recommend that different qualities of residential outdoor environments should be considered individually rather than aggregated as simply “outdoor space.” The findings of this study are expected to contribute to create age-friendly communities for an aging society.

High-Intensity Exercise Improves Fatigue, Sleep, and Mood in Patients With Axial Spondyloarthritis: Secondary Analysis of a Randomized Controlled Trial

OBJECTIVE

Although exercise is recommended in the treatment of axial spondyloarthritis (axSpa), the focus has been on flexibility, and the effect of high-intensity exercises is unknown. The purpose of this study was to investigate the effect of high-intensity exercises on fatigue, sleep, and mood in patients with axSpA.

METHODS

In this secondary analysis of a randomized controlled trial, participants were recruited from outpatient clinics at 4 hospitals in Scandinavia. A total of 100 patients with axSpA were randomized to either an exercise group (n = 50) or a control group (n = 50). High-intensity exercise was provided 3 times per week for 3 months and supervised by a physical therapist. The controls received no intervention. Measurements were self-reported at baseline, 3 months, and 12 months: fatigue, using the Fatigue Severity Scale (range = 0-7, 7 = worst, ≥5 = severe); vitality, using the RAND 36-item short-form health survey (SF-36, range = 0-100, 100 = best); sleep, using the Pittsburgh Sleep Quality Index (range = 0-21, 21 = worst, >5 = poor quality); mood, using the General Health Questionnaire 12 (range = 0-36, 36 = worst); and general health, using the EUROQoL (range = 0-100, 100 = best).

RESULTS

A total of 38 participants (76%) in the exercise group followed ≥80% of the exercise protocol. At 3 months, there was a significant beneficial effect on fatigue (mean group differences = -0.4, 95% CI = -0.7 to -0.1), vitality (5.0, 95% CI = 1.1 to 10.5), mood (-2, 95% CI = -3.7 to -0.04), and general health (9.0, 95% CI = 3.3 to 14.7) but no effect on sleep (-1.1, 95% CI = -2.1 to 0.2). Compared with the control group, the exercise group had a reduced rate of severe fatigue and poor sleep. No differences were seen between the groups at 12 months.

CONCLUSIONS

A 3-month exercise program had a beneficial effect on fatigue, sleep, mood, and general health in patients with axSpA at the end of the intervention; however, no long-term effects were seen.

IMPACT

High-intensity cardiorespiratory and strength exercises should be considered as important in exercise programs for patients with axSpA.

Mental fitness in higher education: Intervention Mapping programme design

Purpose

Higher Education Institutions observe that many students are experiencing mental health issues, such as high levels of anxiety and stress. Young adults are recognised as a vulnerable group who carry the burden of mental health problems worldwide. Mental health interventions can be effective in positively influencing students' emotional and behavioural wellbeing.

Design/methodology/approach

In the current study, the principles of Intervention Mapping (IM) were applied to guide the development, implementation, and evaluation of a specifically tailored mental health programme for a selected student cohort in a large Higher Education Institute in Ireland. Mixed qualitative (Delphi technique and focus group discussions) and quantitative (survey) data were gathered to gain a broad perspective of mental health concerns and learning needs among a sample of higher education students (n = 99).

Findings

Existing evidence guided by theoretical frameworks were blended to create a specifically tailored mental health programme to meet the needs of higher education students in Ireland. Results indicate that the established six-stages of IM provide an empirical process that has the potential to effectively respond to the mental health needs of students in higher education. IM identifies the priority needs of students in higher education and ensures that suitable behaviour change techniques for mental health are addressed. 10;

Originality/value

IM is a suitable method to critically and collaboratively develop a mental health intervention for the overall wellbeing of the general higher education student population, both nationally and globally. 10;

Affect Improvements and Measurement Concordance Between a Subjective and an Accelerometric Estimate of Physical Activity

Abstract. Objectives: Physical activity (PA) positively influences several aspects of mental well-being including affect improvements. Yet, the fact that subjective and objective measures of PA often diverge challenges research on the relationship of PA and affect. Methods: Subjective (ecological momentary assessment, EMA) and objective (combined heart rate and accelerometric activity tracker) measures of PA alongside repeated ratings of positive and negative affects were obtained from 37 participants over 7 consecutive days. Results: Subjective and objective PA were significantly positively correlated. Affect improvements, that is, negative affect decrease as well as positive affect increase, were predicted by both subjective (EMA) and objective (activity tracker) data. Conclusions: Measurement concordance supports the validity of both assessment strategies. Affect improvements result from both subjective representations of one’s own activity as well as from physiological mechanisms of PA that one is not aware of, suggesting two independent routes to affect improvements.

Factors that influence participation in physical activity for anxiety or depression: a synthesis of qualitative evidence

This is a protocol for a Cochrane Review (Qualitative). The objectives are as follows:

Main objective: To identify the factors that create barriers or facilitate physical activity for people with a diagnosis of anxiety or depression from the perspectives of service users, carers, service providers and practitioners to help inform the design and implementation of interventions that promote physical activity.

The overall aim of this review is to identify, appraise, and synthesise qualitative research evidence on the barriers and facilitators to engaging in physical activity in general lifestyle settings or as part of an intervention designed to increase physical activity for people with anxiety and depression. This will allow us to identify factors that create barriers and facilitators of physical activity in this population to inform the development, design, and implementation of future interventions. We will also integrate the findings from the QES with the two associated effectiveness reviews (Cooney 2014 ; Larun 2006 ). We will communicate our findings to public health commissioners and other stakeholders.

Bullying Environment Moderates the Relationship Between Exercise and Mental Health in Bullied US Children

BACKGROUND

Exercise reduces the odds of sadness and suicidality in bullied students, but the role of the bullying environment on this relationship remains unknown.

METHODS

Using combined data from the 2013 and 2015 Youth Risk Behavior Survey (N = 29,207), adjusted logistic regression models estimated odds ratios between exercise, sadness, and suicidal ideation and attempt, stratified by bullying exposure (electronically/at school).

RESULTS

Overall, 40.2% of students bullied at school and 48.3% of students bullied electronically reported feeling sad, compared to 22.6% of those not bullied. Bullied students were 2-3 times more likely to report suicidal ideation, and 3-4 times more likely to report suicidal attempt, regardless of bullying context. Students who were bullied at school and exercised 4-7 days per week had lower odds of sadness (adjusted odds ratio [AOR]: 0.64; 95% confidence interval [CI]: 0.51-0.81), suicidal ideation (AOR: 0.66; 95% CI: 0.53-82), and suicidal attempt (AOR: 0.69; 95% CI: 0.48-0.98) compared to those who exercised 0-3 days. There were no protective effects of exercise for students bullied electronically.

CONCLUSIONS

Exercise reduced sadness and suicidality in adolescents bullied at school but not for students who were cyberbullied. Bullying environment should be a primary consideration in school mental health treatment and maintenance paradigms.

Is physical activity a risk or protective factor for subsequent dietary lapses among behavioral weight loss participants?

OBJECTIVE

Dietary lapses drive weight loss failure, and specific factors influence risk of lapse. Physical activity (PA) may be one such risk factor, though whether PA increases or decreases appetite, and thus risk of lapse, is unclear. In fact, most studies examining the relation between PA and energy intake are limited by use of laboratory-based settings, intensive PA manipulations, and healthy-weight samples. This study aimed to maximize ecological validity by examining the extent to which free-living PA of various intensities prospectively predicts same-day dietary lapses among individuals enrolled in a weight loss program.

METHOD

Participants were 130 adults with overweight/obesity in a behavioral weight loss treatment instructed to follow a PA and dietary prescription. At midtreatment, moderate-to-vigorous PA (MVPA) and light PA were measured using hip-worn Actigraph GT3X+ accelerometers (Actigraph, Pensacola, FL). Lapses were assessed using ecological momentary assessment. Within-subject total PA (b = -0.012, SE = 0.005, p = .01) and light PA (b = -0.014, SE = 0.006, p = .01) negatively predicted lapse. MVPA followed the same pattern, but the effect was not statistically significant (b = -0.013, SE = 0.009, p = .12).

CONCLUSION

This study was the first to investigate if objectively measured PA prospectively predicts lapse from a weight loss program. Results suggested that for every additional 10 min of total PA one engaged in, the risk of lapse decreased by 1%. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Kinect Adventures versus physical exercise on depressive symptoms of older adults: A pilot study

Abstract Introduction: Depressive and anxiety disorders are considered the main cause of emotional suffering and decrease of quality of life among older adults. It has been suggested that the practice of physical exercise can be a treatment option for anxiety and depression. Alternative approaches such serious games show promise for reducing depression symptoms. Objective: To compare the effect of virtual reality, in the form of commercially available interactive Kinect Adventures video games, compared to a standard physical exercise program on depressive symptoms of older adults. Method: This is a pilot study, parallel group, single-blind randomized controlled pilot trial that recruited two intervention groups: Interactive Video Game Kinect Adventures (IVG, n=8) versus usual physical exercise program (PEP, n=6). The two groups completed a seven week program with a total of fourteen 60-minute sessions divided into two sessions a week. The IVG completed individual training sessions using the Microsoft Xbox Kinect Adventures games and the PEP performed a group exercise program. Depression symptoms were measured using the Geriatric Depression Scale (GDS-15). This measure was assessed pre-intervention, post intervention and at 30-day follow-up. Results: There was a significant effect of assessment without group effect or interaction between factors, in the GDS-15 (RM-ANOVA, P < 0.0001). Both groups showed improvement in the GDS-15 post intervention assessment that was maintained after 30-day follow-up (Bonferroni post hoc test, P < 0.05). Conclusion: The results of this study suggest that both Interactive Kinect Adventures video games and physical exercise provide beneficial effects on depressive symptoms of older adults.

Basic psychological needs, exercise intention and sport commitment as predictors of recreational sport participants' exercise adherence

Objective: This study aims to predict exercise adherence by examining from the standpoints of the exercise intention, the self-determination theory and the sport commitment model. Design and Main Outcome Measures: Data were collected from 391 Korean sports centre members (teens: 5.4%, twenties: 15.1%, thirties: 25.1%, forties: 28.1% and ≥ fifties: 26.3%). Questionnaires assessed the exercise intention and sport commitment as well as autonomy, competence and relatedness. Exercise adherence was measured by electronic attendance system. Data were analysed using reliability testing, descriptive statistics, correlation analysis, logistic regression analysis and binary classifier system. Results: All variables except for cognitive commitment had significant predictive power for 3-month exercise adherence. In contrast, only basic psychological needs were found to have significant predictive power for 6-month exercise adherence. Further, autonomy (OR = 4.58) showing the strongest predictive power (classification accuracy = 86.4%). Conclusion: These findings imply that 'basic psychological needs' plays a more key role than 'exercise intention' in predicting exercise adherence. This study has implications that need to focus not only on enjoyment or competition but also on the autonomy, relatedness and competence pertaining to the basic psychological needs and to work to satisfy those needs and maintain motivation to continue regular exercise.

New Insights in Physical Therapy and Rehabilitation in Axial Spondyloarthritis: A Review

Axial spondyloarthritis (axSpA) is a chronic and inflammatory rheumatic disease characterized by pain, structural and functional impairments, and reduced mobility and potential deformity of the axial skeleton. Treatment of axSpA includes pharmacological and non-pharmacological therapy. However, in the biologic era, unmet needs still remain for patients intolerant to or non-responders to biologic drugs and despite the development of new treatments, physical therapy and rehabilitation are of crucial importance in the management of axSpA patients. The aim of this manuscript is to review the current evidence on the assessment, physical therapy, and rehabilitation in axSpA patients.

Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs

The current 'state of play' in supporting elite athlete mental health and wellbeing has centred mostly on building mental health literacy or awareness of the signs of mental ill-health amongst athletes. Such awareness is necessary, but not sufficient to address the varied mental health needs of elite athletes. We call for a new model of intervention and outline the backbone of a comprehensive mental health framework to promote athlete mental health and wellbeing, and respond to the needs of athletes who are at-risk of developing, or already experiencing mental health symptoms or disorders. Early detection of, and intervention for, mental health symptoms is essential in the elite sporting context. Such approaches help build cultures that acknowledge that an athlete's mental health needs are as important as their physical health needs, and that both are likely to contribute to optimising the athlete's overall wellbeing in conjunction with performance excellence. The proposed framework aims at (i) helping athletes develop a range of self-management skills that they can utilise to manage psychological distress, (ii) equipping key stakeholders in the elite sporting environment (such as coaches, sports medicine and high-performance support staff) to better recognise and respond to concerns regarding an athlete's mental health and (iii) highlighting the need for specialist multi-disciplinary teams or skilled mental health professionals to manage athletes with severe or complex mental disorders. Combined, these components ensure that elite athletes receive the intervention and support that they need at the right time, in the right place, with the right person.

Effect of physical activity on suicidal ideation differs by gender and activity level

BACKGROUND

Suicide is a critical complication of psychiatric disorders. Physical activity has a positive effect on mental health; however, its effects on suicidal ideation have received little attention compared to other psychiatric symptoms.

METHODS

Data were obtained from the Korea National Health and Nutrition Examination Survey 2014. Suicidal ideation was measured by the ninth item of the Patient Health Questionnaire-9. Physical activity was measured by the International Physical Activity Questionnaire (IPAQ) and categorized into three groups by activity level. Multiple logistic regression analysis was performed for the entire sample, men, and women. The following three models were used: Model 1 (adjusted for sociodemographic and health-related variables), Model 2 (additionally adjusted for subjective body image), and Model 3 (additionally adjusted for diagnosed depression).

RESULTS

Compared to the low IPAQ group, the moderate IPAQ group was significantly associated with decreased suicidal ideation in Model 3 for the entire sample (OR, 0.733; 95% CI, 0.538-0.999) and in all models for women. However, the high IPAQ group showed no significant association. None of the IPAQ groups showed significant associations in men.

LIMITATIONS

This is a cross-sectional study. Therefore, the direction of causality cannot be determined. This study also investigated suicidal ideation over the past two weeks, which may be inconsistent with studies conducted over the past year.

CONCLUSIONS

The beneficial relationship between physical activity and suicidal ideation is weaker in men and individuals with high activity levels. Detailed guidelines on physical activity according to gender and activity level are recommended.

The "Journal of Functional Morphology and Kinesiology" Journal Club Series: Highlights on Recent Papers in Overtraining and Exercise Addiction

We are glad to introduce the seventeenth Journal Club. This edition is focused on several relevant studies published in the last years in the field of Overtraining and Exercise Addiction, chosen by our Editorial Board members and their colleagues. We hope to stimulate your curiosity in this field and to share with you the passion for the sport seen also from the scientific point of view. The Editorial Board members wish you an inspiring lecture.

Effect of Time-of-Day-Exercise in Group Settings on Level of Mood and Depression of Former Elite Male Athletes

Since the prevalence of depression is high among athletes at the end of their athletic career, the purpose of this study was to investigate the effect of time-of-day-exercise in group settings on the level of the mood and depression of former elite male athletes.Out of 187 volunteers referring to the sports counseling clinic, 71 retired male athletes who had a national championship record were randomly divided into two morning and evening exercise groups. The inclusion criteria were severe depression (high score in the Beck Depression Inventory-II), the age range of 50 to 60 years, the absence of metabolic syndrome, and the body mass index (BMI) between 28 and 35. All body composition variables were measured using body composition analysis (In Body 320; Korea). The second stage was the collection of data after three months (completion of the training protocol). After data collection, independent and dependent t-tests were used to analyze the data. The results indicated that both groups had a significant improvement in depression compared to the pre-test (p ≤ 0.05), while there was no significant difference between the two groups (p ≥ 0.05). The overall conclusion is that exercise at different times of the morning or evening can improve the psychological state and reduce depression.

Flexibility exercise training for adults with fibromyalgia

BACKGROUND

Exercise training is commonly recommended for adults with fibromyalgia. We defined flexibility exercise training programs as those involving movements of a joint or a series of joints, through complete range of motion, thus targeting major muscle-tendon units. This review is one of a series of reviews updating the first review published in 2002.

OBJECTIVES

To evaluate the benefits and harms of flexibility exercise training in adults with fibromyalgia.

SEARCH METHODS

We searched the Cochrane Library, MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database), Thesis and Dissertation Abstracts, AMED (Allied and Complementary Medicine Database), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), and ClinicalTrials.gov up to December 2017, unrestricted by language, and we reviewed the reference lists of retrieved trials to identify potentially relevant trials.

SELECTION CRITERIA

We included randomized trials (RCTs) including adults diagnosed with fibromyalgia based on published criteria. Major outcomes were health-related quality of life (HRQoL), pain intensity, stiffness, fatigue, physical function, trial withdrawals, and adverse events.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected articles for inclusion, extracted data, performed 'Risk of bias' assessments, and assessed the certainty of the body of evidence for major outcomes using the GRADE approach. All discrepancies were rechecked, and consensus was achieved by discussion.

MAIN RESULTS

We included 12 RCTs (743 people). Among these RCTs, flexibility exercise training was compared to an untreated control group, land-based aerobic training, resistance training, or other interventions (i.e. Tai Chi, Pilates, aquatic biodanza, friction massage, medications). Studies were at risk of selection, performance, and detection bias (due to lack of adequate randomization and allocation concealment, lack of participant or personnel blinding, and lack of blinding for self-reported outcomes). With the exception of withdrawals and adverse events, major outcomes were self-reported and were expressed on a 0-to-100 scale (lower values are best, negative mean differences (MDs) indicate improvement). We prioritized the findings of flexibility exercise training compared to land-based aerobic training and present them fully here.Very low-certainty evidence showed that compared with land-based aerobic training, flexibility exercise training (five trials with 266 participants) provides no clinically important benefits with regard to HRQoL, pain intensity, fatigue, stiffness, and physical function. Low-certainty evidence showed no difference between these groups for withdrawals at completion of the intervention (8 to 20 weeks).Mean HRQoL assessed on the Fibromyalgia Impact Questionnaire (FIQ) Total scale (0 to 100, higher scores indicating worse HRQoL) was 46 mm and 42 mm in the flexibility and aerobic groups, respectively (2 studies, 193 participants); absolute change was 4% worse (6% better to 14% worse), and relative change was 7.5% worse (10.5% better to 25.5% worse) in the flexibility group. Mean pain was 57 mm and 52 mm in the flexibility and aerobic groups, respectively (5 studies, 266 participants); absolute change was 5% worse (1% better to 11% worse), and relative change was 6.7% worse (2% better to 15.4% worse). Mean fatigue was 67 mm and 71 mm in the aerobic and flexibility groups, respectively (2 studies, 75 participants); absolute change was 4% better (13% better to 5% worse), and relative change was 6% better (19.4% better to 7.4% worse). Mean physical function was 23 points and 17 points in the flexibility and aerobic groups, respectively (1 study, 60 participants); absolute change was 6% worse (4% better to 16% worse), and relative change was 14% worse (9.1% better to 37.1% worse). We found very low-certainty evidence of an effect for stiffness. Mean stiffness was 49 mm to 79 mm in the flexibility and aerobic groups, respectively (1 study, 15 participants); absolute change was 30% better (8% better to 51% better), and relative change was 39% better (10% better to 68% better). We found no evidence of an effect in all-cause withdrawal between the flexibility and aerobic groups (5 studies, 301 participants). Absolute change was 1% fewer withdrawals in the flexibility group (8% fewer to 21% more), and relative change in the flexibility group compared to the aerobic training intervention group was 3% fewer (39% fewer to 55% more). It is uncertain whether flexibility leads to long-term effects (36 weeks after a 12-week intervention), as the evidence was of low certainty and was derived from a single trial.Very low-certainty evidence indicates uncertainty in the risk of adverse events for flexibility exercise training. One adverse effect was described among the 132 participants allocated to flexibility training. One participant had tendinitis of the Achilles tendon (McCain 1988), but it is unclear if the tendinitis was a pre-existing condition.

AUTHORS' CONCLUSIONS

When compared with aerobic training, it is uncertain whether flexibility improves outcomes such as HRQoL, pain intensity, fatigue, stiffness, and physical function, as the certainty of the evidence is very low. Flexibility exercise training may lead to little or no difference for all-cause withdrawals. It is also uncertain whether flexibility exercise training has long-term effects due to the very low certainty of the evidence. We downgraded the evidence owing to the small number of trials and participants across trials, as well as due to issues related to unclear and high risk of bias (selection, performance, and detection biases). While flexibility exercise training appears to be well tolerated (similar withdrawal rates across groups), evidence on adverse events was scarce, therefore its safety is uncertain.

Quality of Life, Depression, Anxiety Symptoms and Mood State of Wheelchair Athletes and Non-athletes: A Preliminary Study

The present study aims to compare quality of life, depression, anxiety symptoms, and profile of mood state of wheelchair athletes and non-athletes. Thirty-nine basketball and rugby wheelchair athletes (n = 23, nine women, age 36.0 ± 10.0 years; body mass 66.2 ± 13.8 kg; height 170.0 ± 8.5 cm) and non-athletes (n = 16, 4 women, 39.0 ± 14.2 years; body mass 79.6 ± 17.2 kg; height 170.0 ± 6.4 cm) were recruited. Quality of life, anxiety and depressive symptoms and mood disorders were evaluated by the Medical Outcomes Short-Form Health Survey (SF-36), State-Trait Anxiety Inventory, Beck Depression Inventory and Profile of Mood State questionnaire, respectively. Comparison between groups (non-athletes vs. athletes) was performed using Student's t-test for independent samples. No differences (p > 0.05) were found between non-athletes vs. athletes regards to quality of life, depressive and anxiety symptoms and profile of mood state. Overall, non-athletes and athletes presented medium anxiety symptoms and mild to moderate depressive symptoms. In conclusion, the wheelchair athletes and non-athletes presented similar quality of life, depressive and anxiety symptoms, and profile of mood state.

Voluntary exercise reduces plasma cortisol levels and improves transitory memory impairment in young and aged Octodon degus

Sleep deprivation (SD) has been reported to induce transient cognitive impairment in functional domains commonly affected in dementia, including memory. Indeed, sleep disturbance has been proposed as an early marker for Alzheimer's disease (AD). SD emulates many aging-related modifications, including important memory dysfunctions possibly caused by triggers of stress such as cortisol. Although exercise is widely assumed to be beneficial for overall health, only recently has the research community focused its attention on its possible effects on brain functions such as cognition. Octodon degus (O. degus) is a recent rodent model considered suitable for the study of neurodegenerative diseases, since it spontaneously develops several histopathological hallmarks observed in AD. We aimed to uncover the interaction between stress, exercise, age and transient memory impairments after SD insult. In this study, animals had free individual access to wheels to practice voluntary exercise. The Barnes Maze (BM) task was conducted with young and aged O. degus animals after combining voluntary exercise and either normal sleep or SD. Plasma cortisol levels were measured after each condition. SD impaired hippocampus-dependent memory in both young and old animals, while cortisol levels did not significantly differ between non-SD and SD animals. However, voluntary exercise for 45 days improved the cognitive impairment caused by SD compared with the control condition. Moreover, voluntary exercise decreased plasma cortisol levels in both conditions, independently of the age.

Flow and Satisfaction With Life in Elite Musicians and Top Athletes

Although flow has been studied extensively in music and sport, there is a lack of research comparing these two domains. With the aim of filling this gap, elite musicians and top athletes in Slovenia were contrasted in the current study. Differences for flow and satisfaction with life between elite musicians and top athletes were explored. Individual versus group performance setting and gender differences were considered. 452 participants; 114 elite Slovenian musicians (mean age 23.46 years) and 338 top Slovenian athletes (mean age 22.40 years) answered questions about flow and satisfaction with life measures. The results show differences between elite musicians and top athletes in four flow dimensions: transformation of time and autotelic experience were higher in musicians while clear goals and unambiguous feedback were higher in athletes. However, differences in global flow were not confirmed. Elite musicians and top athletes experienced flow more often in group than in individual performance settings and surprisingly it was experienced more in male than in female top performers. Satisfaction with life has a positive correlation with all nine dimensions of flow, but only challenge-skill balance was a significant predictor for satisfaction with life.

The effects of aerobic exercise training on mental health and self-esteem of type 2 diabetes mellitus patients

Physical and mental health are very closely tied and either of them can exert a significant effect on the other. The aim of the present study was to examine the effects of aerobic exercise training on mental health and self-esteem of type 2 diabetes mellitus patients. 60 participants, aged 40 to 55 years, with blood sugar ranging between 150 to 250 mg/dL participated in the study. They were randomly divided into two groups of 30 patients. The inter-ventional group exercised for twelve weeks, three sessions per week, lasting from 45 to 60 minutes, followed by endurance training on treadmill. Training's intensity was considered equal to 60-70% of maximum oxygen consumption. According to the results of the study, 12-week aerobic exercise training had significant effects on self-esteem (P=0.001), and mental health (P=0.020), sub-scales of physical symptoms (P=0.001), and anxiety and insomnia (P=0.044). But it had no significant effects on the sub-scales of depression (P=0.078) and social functioning (P=0.207). Regular aerobic exercise training as an effective strategy plays an important role in improving self-esteem and mental health and also promoting life quality among diabetic patients.

Physical activity during pregnancy and postpartum depression: Systematic review and meta-analysis

BACKGROUND

It is still largely unknown whether physical activity (PA) during pregnancy may be useful to avert subsequent postpartum depression (PPD). We conducted a systematic review and meta-analysis to determine the preventive effects of PA during pregnancy on PPD.

METHODS

A systematic review of English and non-English articles was conducted using CINAHL, Cochrane Controlled Trials Register, PsycINFO, MEDLINE, SportDiscuss and Web of Science databases. Studies which tested the effect of any type of PA measured during pregnancy on depression or depressive symptoms in the first year postpartum were included. Relevant articles were extracted independently by 2 authors using predefined data fields, including study quality indicators. The protocol was registered on PROSPERO (CRD42018087086).

RESULTS

Twenty one studies, fit our selection criteria. Among them, seventeen studies were included in the meta-analysis, representing 93 676 women. Robust Variance Estimation random-effects meta-analysis indicated a significant reduction in postpartum depression scores (Overall SMD = -0.22 [95% CI -0.42 to -0.01], p = 0.04; I² = 86.4%) for women physically active during pregnancy relative to those who were not active. This association was reinforced in intervention studies (SMD = -0.58 [9% CI -1.09 to -0.08]).

LIMITATIONS

Overall meta-analysis showed important heterogeneity in PA assessment, suggesting the existence of potential moderators such as intensity, frequency, trimester of pregnancy or type of physical activity practiced.

CONCLUSIONS

PA during pregnancy appears to reduce the risk of PPD symptoms. High quality studies addressing the role of PA in the perinatal period and its impact on new mother's mental health remain necessary.

Identifying Behaviors Predicting Early Morning Emotions by Observing Permanent Supportive Housing Residents: An Ecological Momentary Assessment

BACKGROUND

Behavior and emotions are closely intertwined. The relationship between behavior and emotions might be particularly important in populations of underserved people, such as people with physical or mental health issues. We used ecological momentary assessment (EMA) to examine the relationship between emotional state and other characteristics among people with a history of chronic homelessness who were participating in a health coaching program.

OBJECTIVE

The goal of this study was to identify relationships between daily emotional states (valence and arousal) shortly after waking and behavioral variables such as physical activity, diet, social interaction, medication compliance, and tobacco usage the prior day, controlling for demographic characteristics.

METHODS

Participants in m.chat, a technology-assisted health coaching program, were recruited from housing agencies in Fort Worth, Texas, United States. All participants had a history of chronic homelessness and reported at least one mental health condition. We asked a subset of participants to complete daily EMAs of emotions and other behaviors. From the circumplex model of affect, the EMA included 9 questions related to the current emotional state of the participant (happy, frustrated, sad, worried, restless, excited, calm, bored, and sluggish). The responses were used to calculate two composite scores for valence and arousal.

RESULTS

Nonwhites reported higher scores for both valence and arousal, but not at a statistically significant level after correcting for multiple testing. Among momentary predictors, greater time spent in one-on-one interactions, greater time spent in physical activities, a greater number of servings of fruits and vegetables, greater time spent interacting in a one-on-one setting as well as adherence to prescribed medication the previous day were generally associated with higher scores for both valence and arousal, and statistical significance was achieved in most cases. Number of cigarettes smoked the previous day was generally associated with lower scores on both valence and arousal, although statistical significance was achieved for valence only when correcting for multiple testing.

CONCLUSIONS

This study provides an important glimpse into factors that predict morning emotions among people with mental health issues and a history of chronic homelessness. Behaviors considered to be positive (eg, physical activity and consumption of fruits and vegetables) generally enhanced positive affect and restrained negative affect the following morning. The opposite was true for behaviors such as smoking, which are considered to be negative.

Men, Mental Health and Elite Sport: a Narrative Review

Mental health in elite sport is receiving more publicity due to an increase in male athletes sharing their personal experiences. Sports injury is recognised as the major risk factor for psychological distress amongst male athletes, although anecdotally this may be that athletes are more likely to discuss their emotional wellbeing when related to the injury they are experiencing. Stress can be amplified within elite sport and the pressure they experience in relation to competition and performance can be exacerbated by adverse life events. This ongoing stress does not end when their sporting career does, it can follow them into retirement. The physical and psychological demands placed upon them by the sporting environment may predispose athletes to developing depression. As an athlete’s symptoms of mental illness intensify, their performance can be negatively affected leaving them vulnerable and exposed to further symptoms of common mental disorders. The pressure of performance can also expose male athletes to overtraining syndrome which can be difficult to distinguish from depression. Male athletes are more vulnerable to eating disorders compared with males in the general population and they do have anxieties, particularly around their bodies, but find it difficult to disclose their concerns. In addition to this, male athletes are more likely to use substances, including opioids to improve both sport and non-sport performance.

Despite the prevalence of common mental disorders in male athletes, stigma still exists, and although some athletes discuss their issues publicly after their career has ended, the majority of athletes prefer to remain silent. There remains a view that athletes who seek help for psychological problems may be seen as weak. Although there is an improvement in help-seeking attitudes within elite sport, further research and education is needed to encourage men to talk about their mental health, share their experiences and to enjoy a greater sense of emotional wellbeing.

Anaerobic Exercise Training in the Therapy of Substance Use Disorders: A Systematic Review

Background: In the past 3 decades, there has been an increase in the number of studies assessing exercise as a form of treatment for substance use disorders (SUDs). While a variety of substance types and outcomes have been assessed, exercise intensities have never been systematically examined. Consequently, it remains unclear whether particular forms of exercise are better suited to the treatment of these populations. Anaerobic exercise has been shown to have positive effects in populations with psychiatric disorders, but its effectiveness in the treatment of SUDs has to date not been reviewed. Methods: The aim of this systematic review is to identify and evaluate studies which have employed either an acute or chronic anaerobic exercise component as a therapy modality for SUDs. The primary outcomes are abstinence, craving, withdrawal, consumption, quality of life, and the following psychological symptoms and disorders: depression, anxiety, stress, and mood. A secondary objective is to assess whether the type of training described in the study protocol can be reliably categorized as anaerobic training. Results: Twenty-six studies are included in this review. Twelve studies addressed nicotine dependence, one addressed alcohol dependence, and 13 addressed dependence on various illicit drugs. Thirteen studies reported the intensity at which participants actually exercised, but only one employed a test to determine whether training was carried out above the anaerobic threshold (AT). The risk of bias in the included studies was generally high. Results of the studies were mixed, with the most positive effects being found for abstinence in nicotine dependence. Conclusion: The evidence for the effects of anaerobic exercise in SUDs is weak, although a tendency toward positive effects on abstinence in nicotine dependent individuals was observable. The majority of studies do not report data on exercise intensity, making a categorization of anaerobic exercise impossible in all but one case. This means that the effects of this form of exercise cannot be determined, and therefore not evaluated or compared with other forms. In order to improve the quality of evidence for exercise in SUD treatment, clearly defined and objectively assessed evaluations of anaerobic and anaerobic exercise are necessary.

Examination of Current Treatments and Symptom Management Strategies Used by Patients With Mal De Debarquement Syndrome

Introduction: Mal de Debarquement Syndrome (MdDS) is a neurological disorder which affects the vestibular system pathways, manifesting as a constant sensation of movement in the form of rocking, bobbing, or swaying. The mechanism of MdDS is poorly understood and there is a lack of awareness amongst medical professionals about the condition. This study aimed to examine treatments and symptom management strategies used by MdDS patients and evaluate their self-reported effectiveness.

Method: Motion-Triggered and Spontaneous/Other onset MdDS patients responded to a set of comprehensive questions as a retrospective survey regarding epidemiological details, diagnostic procedures, onset, and symptom triggers, hormonal influences as well as treatments and symptom management strategies used to reduce symptoms. The Motion-Triggered questionnaire was made available through Survey Monkey and the Spontaneous/Other Onset questionnaire through Qualtrics. The link for each questionnaire was made available on online MdDS support groups and on various research websites. Descriptive statistics were used for epidemiological data and Pearson's Chi Square tests were used for comparisons between and within both subtype groups.

Results: A total of 370 patients participated in the surveys, with 287 valid responses collected for the section regarding treatment and symptom management strategies. The success of the treatments and symptom management strategies did not vary between subtypes Benzodiazepines/Antidepressants were reported as being most beneficial in reducing symptoms in both groups.

Conclusion: This was the first attempt to evaluate the reported success of treatments and symptom management strategies in MdDS patients by assessing the patients' perceived helpfulness. The treatments and symptom management strategies reported to be the most helpful in managing and/or reducing symptoms are proposed to be effective due to their stress-reducing capacities. We hope this study will broaden MdDS awareness and that this study will increase patient knowledge regarding treatments and symptom management strategies that other patients found helpful.

Domain-specific physical activity and affective wellbeing among adolescents: an observational study of the moderating roles of autonomous and controlled motivation

BACKGROUND

Abundant evidence demonstrates a relationship between physical activity and mental wellbeing. However, the strength of the relationship is not consistent. Factors contributing to variation in the strength of association are not well understood and, therefore, it remains difficult to optimize physical activity to ensure the strongest possible relationship with mental health. Self-determination theory suggests that more autonomously motivated behaviors lead to better mental health outcomes, when compared to more controlled behaviors. Therefore, we examined whether autonomous and controlled motivation moderated the relationships between physical activity and affective wellbeing within two domains (i.e., leisure-time and active travel).

METHODS

Between February and April 2014, adolescents (N = 1632, M age = 12.94 years, SD = 0.54, 55% male) wore an accelerometer across seven-days and completed self-report measures of leisure-time physical activity and active travel. They also completed two measures of motivation (towards leisure-time physical activity and active travel) and an affective wellbeing measure.

RESULTS

Structural equation modeling revealed that greater self-reported leisure-time physical activity was associated with greater positive affect (β = .29) and less negative affect (β = -.19) and that motivation did not moderate these relationships. Self-reported active travel had no linear relationship with affective wellbeing, and motivation did not moderate these relationships. Accelerometer-measured leisure-time physical activity had no relationship with positive affect but, had a weak inverse association with negative affect (β = -.09), and neither relationship was moderated by motivation. Accelerometer-measured active travel had no association with positive affect; however, autonomous motivation significantly moderated this association such that active travel had a positive association with positive affect when autonomous motivation was high (β = .09), but a negative association when autonomous motivation was low (β = -.07). Accelerometer-measured active travel had no association with negative affect. Despite some significant moderation effects, motivation did not consistently moderate the relationship between all physical activity variables (leisure-time and active travel, and self-report and accelerometer) and affective outcomes.

CONCLUSIONS

Tailoring physical activity interventions and guidelines to prioritize leisure-time ahead of other life domains could benefit wellbeing. Promoting autonomous participation in active travel may also be associated with increased wellbeing among adolescents.

Different associations of sufficient and vigorous physical activity with BMI in Northwest China

Physical activity (PA) plays an important role in maintaining a healthy weight. To develop targeted strategies that encourage physical activity, knowledge of associations between intensity of physical activity (PA) levels and body mass index (BMI) is essential. We aimed to examine the relationship between sufficient and vigorous PA and BMI distribution among adults in northwest China using quantile regression. We conducted a cross-sectional study in Shaanxi Province in 2013, using proportional probability sampling. BMI was calculated using measured height and weight. The Global Physical Activity Questionnaire was used to define and measure sufficient and vigorous PA. Associations of sufficient/vigorous PA and BMI were modelled using quantile regression. Mean BMI was 24.18 ± 3.51 and BMI distribution with age showed an inverse U shape. A total 9045 (88.97%) participants demonstrated sufficient PA and 3119 (30.68%) reported vigorous PA. After adjusting for relevant sociodemographic, dietary, and lifestyle parameters in quantile regression modelling, sufficient PA was positively associated with BMI score distribution from the 1st to 30th quantile, with β from 0.32 (95% confidence interval (CI): 0.07 to 0.63) to 0.85 (95% CI: 0.40 to 1.19). Vigorous PA was negatively associated with BMI score distribution from the 30th to 93th quantiles, with β from -0.18 (95% CI: -0.31 to -0.02) to -0.81 (95% CI: -1.10 to -0.45). Sufficient PA was positively associated with underweight and normal weight whereas vigorous PA was negatively associated with overweight and obesity.

Endocrine Crosstalk Between Skeletal Muscle and the Brain

Skeletal muscle is an essential regulator of energy homeostasis and a potent coordinator of exercise-induced adaptations in other organs including the liver, fat or the brain. Skeletal muscle-initiated crosstalk with other tissues is accomplished though the secretion of myokines, protein hormones which can exert autocrine, paracrine and long-distance endocrine effects. In addition, the enhanced release or uptake of metabolites from and into contracting muscle cells, respectively, likewise can act as a powerful mediator of tissue interactions, in particular in regard to the central nervous system. The present review will discuss the current stage of knowledge regarding how exercise and the muscle secretome improve a broad range of brain functions related to vascularization, neuroplasticity, memory, sleep and mood. Even though the molecular and cellular mechanisms underlying the communication between muscle and brain is still poorly understood, physical activity represents one of the most effective strategies to reduce the prevalence and incidence of depression, cognitive, metabolic or degenerative neuronal disorders, and thus warrants further study.

Differences in pain and function between adolescent athletes and physically active non-athletes with patellofemoral pain

OBJECTIVES

To investigate pain level and function limitation in adolescent athletes and physically active non-athletes with PFP.

DESIGN

Cross-sectional study.

SETTING

Adolescent athletes were recruited at a sport center complex. Adolescent non-athletes were recruited from upper secondary schools.

PARTICIPANTS

108 adolescents diagnosed with PFP: 42 adolescent athletes and 66 adolescent non-athletes.

MAIN OUTCOME MEASURES

To evaluate the level of pain, a visual analog scale (VAS) was used and to evaluate the overall function, the Knee Outcome in Osteoarthritis Survey (KOOS) was used.

RESULTS

The adolescent athletes scored significantly higher in the VAS (Mean difference = 0.97 (95% CI = 0.35; 1.60) p = 0.003) compared to adolescent non-athletes. Adolescent athletes scored lower in the KOOS - Symptoms, Pain, Knee-related quality of life and Sport and recreation dimensions - than the non-athletes, however, the minimally clinically important difference was not achieved in Pain dimension. There was no significant difference in the Activities of daily living dimension of the KOOS.

CONCLUSIONS

Adolescent athletes presented higher levels of pain and lower physical function status compared with physically active non-athletes. This provides an important insight to the management of PFP in adolescent athletes as worst functional status is linked with poor prognosis in patients with PFP.

The effect of the type of physical activity on the perceived stress level in people with activity limitations

The purpose of this study was to investigate the effect of the type of physical activity that people with activity limitations participate in on their perceived stress level. We analyzed the data of the Korean National Health and Nutrition Examination Survey (KNHANES) conducted annually from 2007 to 2015. The subjects of the study were adults aged 19 or older who had activity limitations. The data analysis was done using the SPSS ver. 18.0 program, and complex sampling design frequencies analysis and logistic regression analysis were conducted. The statistical significance level was set at P<0.05. The results of this study are as follows: First, in the case of males with activity limitations, the odds ratio (OR) for the perceived stress level for those who participated in walking exercise compared to those who did not was 0.707 (95% confidence interval [CI], 0.535–0.934; P<0.05). Second, for males with activity limitations, the OR for the perceived stress level for those who participated in walking exercise for 5 days or more compared to the nonparticipation group was 0.630 (95% CI, 0.472–0.841; P<0.05). Third, for females with activity limitations, the OR for the perceived stress level for those who participated in flexibility exercise compared to those who did not was 0.869 (95% CI, 0.727–1.039; P<0.05). Fourth, for females with activity limitations, the OR for the perceived stress level for those who participated in flexibility exercise for 5 days or more compared to the nonparticipation group was 0.672 (95% CI, 0.539–0.838; P<0.05).

Effects of Sleep, Physical Activity, and Shift Work on Daily Mood: a Prospective Mobile Monitoring Study of Medical Interns

BACKGROUND

Although short sleep, shift work, and physical inactivity are endemic to residency, a lack of objective, real-time information has limited our understanding of how these problems impact physician mental health.

OBJECTIVE

To understand how the residency experience affects sleep, physical activity, and mood, and to understand the directional relationships among these variables.

DESIGN

A prospective longitudinal study.

SUBJECTS

Thirty-three first-year residents (interns) provided data from 2 months pre-internship through the first 6 months of internship.

MAIN MEASURES

Objective real-time assessment of daily sleep and physical activity was assessed through accelerometry-based wearable devices. Mood scaled from 1 to 10 was recorded daily using SMS technology. Average compliance rates prior to internship for mood, sleep, and physical activity were 77.4, 80.2, and 93.7%, and were 78.8, 53.0, and 79.9% during internship.

KEY RESULTS

After beginning residency, interns lost an average of 2 h and 48 min of sleep per week (t = - 3.04, p < .01). Mood and physical activity decreased by 7.5% (t = - 3.67, p < .01) and 11.5% (t = - 3.15, p < .01), respectively. A bidirectional relationship emerged between sleep and mood during internship wherein short sleep augured worse mood the next day (b = .12, p < .001), which, in turn, presaged shorter sleep the next night (b = .06, p = .03). Importantly, the effect of short sleep on mood was twice as large as mood's effect on sleep. Lastly, substantial shifts in sleep timing during internship (sleeping ≥ 3 h earlier or later than pre-internship patterns) led to shorter sleep (earlier: b = - .36, p < .01; later: b = - 1.75, p < .001) and poorer mood (earlier: b = - .41, p < .001; later: b = - .41, p < .001).

CONCLUSIONS

Shift work, short sleep, and physical inactivity confer a challenging environment for physician mental health. Efforts to increase sleep opportunity through designing shift schedules to allow for adequate opportunity to resynchronize the circadian system and improving exercise compatibility of the work environment may improve mood in this depression-vulnerable population.

High-intensity cardiorespiratory and strength exercises reduced emotional distress and fatigue in patients with axial spondyloarthritis: a randomized controlled pilot study

OBJECTIVE

To investigate the effect of high-intensity exercise on emotional distress, fatigue, and ability to do a full day's activities in patients with axial spondyloarthritis (axSpA).

METHOD

A total of 28 physically inactive axSpA patients were randomized to either an exercise group (EG), which performed 12 weeks of cardiorespiratory and strength exercises, or a control group (CG), which received treatment as usual. The outcomes reported in this paper are secondary outcomes in the trial and included emotional distress (General Health Questionnaire-12, 0-36, 36 = worst), fatigue [numeric rating scale (NRS), 0-10, 10 = worst], and ability to do a full day's activities (NRS, 0-10, 10 = worst). Post-intervention differences were assessed by analysis of covariance with baseline values as covariates.

RESULTS

Twenty-four patients were included in the analyses. All patients in the EG followed the exercise protocol. The EG had a statistically significant beneficial effect [mean group differences (95% confidence interval)] on emotional distress [-5.8, (-9.7, -1.9), p < 0.01], fatigue [-2.4, (-4.3, -0.4), p = 0.02], and ability to do a full day's work [-2.2, (-3.9, -0.4), p = 0.02] compared to the CG.

CONCLUSION

This pilot study showed promising effects of cardiorespiratory and strength exercises on emotional distress, fatigue, and ability to do a full day's activities in patients with axSpA. The findings need to be confirmed in a larger trial.

Relationship Among Physical Activity Level, Mood and Anxiety States and Quality of Life in Physical Education Students

BACKGROUND

Physical activity level (PAL) is known to play an important role in reducing risk factors associated with sedentarism, in addition to improving the mental health and health-related quality of life (HRQL).

OBJECTIVE

Investigate the relationship of PAL and their domains with HRQL, mood state (MS) and anxiety. Method: 140 Physical Education students (23.6 ± 3.7 years) were evaluated. The Baecke Habitual Physical Activity and Quality of Life (QOL-36) questionnaires, State-Trait Anxiety Inventories (STAI-S and STAI-T) and Profile of Mood States (POMS) scale were used to investigate PAL, HRQL and mental health indicators. Pearson's correlation coefficient examined the association between PAL and both mental health and HRQL parameters.

RESULTS

There was a correlation between state anxiety and both the domain leisure-time physical activity (LTPA) (p = 0.013) and total PAL score (p = 0.010). In relation to MS, a negative correlation was found between LTPA and total mood disorder (TMD) (p = 0.004). However, there were positive correlations between the vigor subscale and both LTPA (p=0.001) and total PAL (p=0.019). With respect to HRQL, analysis of the relationship between LTPA and total PAL demonstrated positive coefficients with the physical component summary (PCS) (p=0.000; p = 0.005), mental component summary (MCS) (p = 0.000; p = 0.006) and total HRQL (p = 0.000; p = 0.003).

CONCLUSION

The findings suggest that the rise in LTPA was related to an increase in HRQL and MS. However, PAL was positively related to anxiety.

The Effects of Cognitive-Behavioral Model-Based Intervention on Depression, Anxiety, and Self-Efficacy in Alcohol Use Disorder

Exercise is constantly gaining attention as adjuvant treatment for alcohol use disorder (AUD), supplementing classical pharmacological and psychotherapeutic approaches. The aim of this study was to determine the effects of cognitive-behavioral model-based (CBM-based) intervention on the depression, anxiety, and self-efficacy levels in AUD. This quasi-experimental study was conducted using pre- and posttests and repeated measurements with a control group; it was completed between February 2015 and August 2015 in Turkey. Participants were 41 individuals with AUD, 20 in the experimental group and 21 in the control group. The individuals in the experimental group performed aerobic exercise 3 days a week as well as attended the psychoeducation provided 1 day a week. The difference between mean scores of the individuals in the experimental and control groups taken in posttest and 4-month follow-up test in the Beck Depression Inventory (BDI) as well as the difference between mean posttest scores in the Beck Anxiety Inventory (BAI) and Self-Efficacy Scale (SES) were found to be statistically significant ( p < .05). In the intragroup comparisons, a significant difference was found between the “BDI,” “BAI,” and “SES” measurement times ( p < .05). It was concluded that CBM-based intervention was effective in reducing depression and anxiety, increasing self-efficacy in individuals with AUD. Appropriate nurse-managed CBM-based intervention for individuals with AUD can promote their health.

Exploring Motivation and Barriers to Physical Activity among Active and Inactive Australian Adults

Physical inactivity is a major global public health issue associated with a range of chronic disease outcomes. As such, the underlying motivation and barriers to whether or not an individual engages in physical activity is of critical public health importance. This study examines the National Heart Foundation of Australia Heart Week Survey conducted in March 2015. A total of 894 (40% female) Australian adults aged 25⁻54 years completed the survey, including items relating to motivation and barriers to being physically active. The most frequently selected responses regarding motivation for physical activity among those categorised as active (n = 696) were; to lose or maintain weight (36.6%, 95% CI 33.1⁻40.3), avoid or manage health condition (17.8%, 95% CI 15.1⁻20.8), and improve appearance (12.8%, 95% CI 10.5⁻15.5). Some gender differences were found with a greater proportion of females (43.8%, 95% CI 38.0⁻49.8) reporting lose or maintain weight as their main motivation for being physically active compared to males (31.9%, 95% CI 27.7⁻36.6). Among those categorised as inactive (n = 198), lack of time (50.0%, 95% CI 43.0⁻56.8) was the most frequently reported barrier to physical activity. While empirical studies seek to understand the correlates and determinants of physical activity, it is critical that beliefs and perceptions enabling and prohibiting engagement are identified in order to optimise physical activity promotion in the community.

The relationship between bicycle commuting and perceived stress: a cross-sectional study

INTRODUCTION

Active commuting - walking and bicycling for travel to and/or from work or educational addresses - may facilitate daily, routine physical activity. Several studies have investigated the relationship between active commuting and commuting stress; however, there are no studies examining the relationship between solely bicycle commuting and perceived stress, or studies that account for environmental determinants of bicycle commuting and stress. The current study evaluated the relationship between bicycle commuting, among working or studying adults in a dense urban setting, and perceived stress.

METHODS

A cross-sectional study was performed with 788 adults who regularly travelled to work or study locations (excluding those who only commuted on foot) in Barcelona, Spain. Participants responded to a comprehensive telephone survey concerning their travel behaviour from June 2011 through to May 2012. Participants were categorised as either bicycle commuters or non-bicycle commuters, and (based on the Perceived Stress Scale, PSS-4) as either stressed or non-stressed. Multivariate Poisson regression with robust variance models of stress status based on exposures with bicycle commuting were estimated and adjusted for potential confounders.

RESULTS

Bicycle commuters had significantly lower risk of being stressed than non-bicycle commuters (Relative Risk; RR (95% CI)=0.73 (0.60 to 0.89), p=0.001). Bicycle commuters who bicycled 4 days per week (RR (95% CI)=0.42 (0.24 to 0.73), p=0.002) and those who bicycled 5 or more days per week (RR (95% CI)=0.57 (0.42 to 0.77), p<0.001) had lower risk of being stressed than those who bicycled less than 4 days. This relationship remained statistically significant after adjusting for individual and environmental confounders and when using different cut-offs of perceived stress.

CONCLUSIONS

Stress reduction may be an important consequence of routine bicycle use and should be considered by decision makers as another potential benefit of its promotion.

Leisure time physical activity and quality of life in medical students: results from a multicentre study

BACKGROUND/AIM

We evaluated the association between leisure time physical activity (PA) and quality of life (QoL) in medical students. Our hypothesis was that there was a positive association between volume of PA and various domains of perception of QoL.

METHODS

Data were evaluated from a random sample of 1350 medical students from 22 Brazilian medical schools. Information from participants included the WHO Quality of Life questionnaire-short form (WHOQOL-BREF), a questionnaire specifically designed to evaluate QoL in medical students (VERAS-Q) and questions for both global QoL self-assessment and leisure time PA. According to the amount of metabolic equivalents (METs) spend during PA, volunteers were divided into four groups, according to the volume of PA: (a) no PA; (b) low PA, ≤540 MET min/week; (c) moderate PA, from 541 to 1260 MET min/week and (d) high PA, > 1261 MET min/week.

RESULTS

Forty per cent of the medical students reported no leisure time PA (46.0% of females and 32.3% of males). In contrast, 27.2% were classified in the group of high PA (21.0% of females and 34.2% of males). We found significant associations between moderate and high levels of PA and better QoL for all measurements. For low levels of PA, this association was also significant for most QoL measurements, with the exceptions of WHOQOL physical health (p=0.08) and social relationships (p=0.26) domains.

CONCLUSION

We observed a strong dose-effect relationship between the volume of leisure time PA and QoL in both male and female medical students.

The Mental Health of Elite Athletes: A Narrative Systematic Review

Background

The physical impacts of elite sport participation have been well documented; however, there is comparatively less research on the mental health and psychological wellbeing of elite athletes.

Objective

This review appraises the evidence base regarding the mental health and wellbeing of elite-level athletes, including the incidence and/or nature of mental ill-health and substance use.

Methods

A systematic search of the PubMed, EMBASE, SPORTDiscus, PsycINFO, Cochrane and Google Scholar databases, up to and including May 2015, was conducted.

Results

The search yielded a total of 2279 records. Following double screening, 60 studies were included. The findings suggested that elite athletes experience a broadly comparable risk of high-prevalence mental disorders (i.e. anxiety, depression) relative to the general population. Evidence regarding other mental health domains (i.e. eating disorders, substance use, stress and coping) is less consistent. These results are prefaced, however, by the outcome of the quality assessment of the included studies, which demonstrated that relatively few studies (25 %) were well reported or methodologically rigorous. Furthermore, there is a lack of intervention-based research on this topic.

Conclusion

The evidence base regarding the mental health and wellbeing of elite athletes is limited by a paucity of high-quality, systematic studies. Nonetheless, the research demonstrates that this population is vulnerable to a range of mental health problems (including substance misuse), which may be related to both sporting factors (e.g. injury, overtraining and burnout) and non-sporting factors. More high-quality epidemiological and intervention studies are needed to inform optimal strategies to identify and respond to player mental health needs.

Electronic supplementary material

The online version of this article (doi:10.1007/s40279-016-0492-2) contains supplementary material, which is available to authorized users.

Depressive symptoms in high-performance athletes and non-athletes: a comparative meta-analysis

OBJECTIVE

To assess whether a difference exists in the prevalence of mild or more severe depressive symptoms between high-performance athletes and non-athletes.

DESIGN

Comparative OR meta-analysis.

DATA SOURCES

We searched PsycINFO, PubMed, MEDLINE, CINAHL, SPORTDiscus and Google Scholar, as well as the reference lists of reviews of mental health issues in high-performance athletes.

ELIGIBILITY

We included studies that compared high-performance athletes and non-athletes, included a validated measure of depressive symptoms and included the prevalence of individuals who indicated at least mild depressive symptoms.

RESULTS

Five articles reporting data from 1545 high-performance athletes and 1811 non-athletes were examined. A comparative OR meta-analysis found high-performance athletes were no more likely than non-athletes to report mild or more severe depressive symptoms (OR=1.15, 95% CI=0.954 to 1.383, p=0.145). Male high-performance athletes (n=940) were no more likely than male non-athletes (n=605) to report mild or more severe depressive symptoms (OR=1.17, 95% CI=0.839 to 1.616, p=0.362). For females, high-performance athletes (n=948) were no more likely than non-athletes (n=605) to report mild or more severe depressive symptoms (OR=1.11, 95% CI=0.846 to 1.442, p=0.464). Overall, male high-performance athletes (n=874) were 52% less likely to report mild or more severe depressive symptoms than female high-performance athletes (n=705) (OR=0.48, 95% CI=0.369 to 0.621, p<0.001).

SUMMARY/CONCLUSIONS

High-performance athletes were just as likely as non-athletes to report depressive symptoms. Researchers need to move beyond self-report measures of depressive symptoms and examine the prevalence of clinically diagnosed depressive disorders in athletes.

Car free cities: Pathway to healthy urban living

BACKGROUND

Many cities across the world are beginning to shift their mobility solution away from the private cars and towards more environmentally friendly and citizen-focused means. Hamburg, Oslo, Helsinki, and Madrid have recently announced their plans to become (partly) private car free cities. Other cities like Paris, Milan, Chengdu, Masdar, Dublin, Brussels, Copenhagen, Bogota, and Hyderabad have measures that aim at reducing motorized traffic including implementing car free days, investing in cycling infrastructure and pedestrianization, restricting parking spaces and considerable increases in public transport provision. Such plans and measures are particularly implemented with the declared aim of reducing greenhouse gas emissions. These reductions are also likely to benefit public health.

AIMS

We aimed to describe the plans for private car free cities and its likely effects on public health.

METHODS

We reviewed the grey and scientific literature on plans for private car free cities, restricted car use, related exposures and health.

RESULTS

An increasing number of cities are planning to become (partly) private car free. They mainly focus on the reduction of private car use in city centers. The likely effects of such policies are significant reductions in traffic-related air pollution, noise, and temperature in city centers. For example, up to a 40% reduction in NO2 levels has been reported on car free days. These reductions are likely to lead to a reduction in premature mortality and morbidity. Furthermore the reduction in the number of cars, and therefore a reduction in the need for parking places and road space, provides opportunities to increase green space and green networks in cities, which in turn can lead to many beneficial health effects. All these measures are likely to lead to higher levels of active mobility and physical activity which may improve public health the most and also provide more opportunities for people to interact with each other in public space. Furthermore, such initiatives, if undertaken at a sufficiently large scale can result in positive distal effects and climate change mitigation through CO2 reductions. The potential negative effects which may arise due to motorized traffic detouring around car free zone into their destinations also need further evaluation and the areas in which car free zones are introduced need to be given sufficient attention so as not to become an additional way to exacerbate socioeconomic divides. The extent and magnitude of all the above effects is still unclear and needs further research, including full chain health impact assessment modeling to quantify the potential health benefits of such schemes, and exposure and epidemiological studies to measure any changes when such interventions take place.

CONCLUSIONS

The introduction of private car free cities is likely to have direct and indirect health benefits, but the exact magnitude and potential conflicting effects are as yet unclear. This paper has overviewed the expected health impacts, which can be useful to underpin policies to reduce car use in cities.