Association of Efficacy of Resistance Exercise Training With Depressive Symptoms: Meta-analysis and Meta-regression Analysis of Randomized Clinical Trials

Effects of an exercise program linked to primary care on depression in elderly: fitness as mediator of the improvement

PURPOSE

The present study aimed to analyse the effects of 12 months of participation in a public physical activity program linked to primary care on depression level and fitness, and to determine which fitness components were responsible for the improvement in depression using mediation analysis.

METHODS

Participants of this program were 2768 middle-aged and older adults from 67 municipalities throughout the Spanish region of Extremadura. In the analysis only participants with depression and without any missing values for fitness variables were included. This sample was 303 for exercise group and 74 for control group. Socio-demographic data, Geriatric Depression Scale and some fitness tests were applied at baseline and 1 year later. Exercise group performed the program 3 days/week for 50-60 min per session involving brisk walking with intermittent flexibility, strength and balance activities/exercises. Socializing within the group was encouraged in all sessions. Data analysis included analysis of covariance, chi-squared and effect size statistics. Additionally, a parallel model of mediation analysis was performed to determine the indirect effect of the participation in the exercise program on depression through improvements in fitness.

RESULTS

A considerable reduction from mild, moderate or severe depression to non-depression were obtained for exercise group (68%) P-value < .05. The parallel mediation analysis showed that flexibility (sit-and-reach [β - 0.04 (- 0.07 to - 0.01)], back scratch [β - 0.06 (- 0.12 to - 0.02)]) and cardiorespiratory fitness (6-min walk [β - 0.09 (- 0.15 to - 0.04)]) were mediators of the reduction in depression.

CONCLUSION

This exercise program was effective in improving depression in older adults. Integrating aerobic and flexibility exercises in a group-based program of physical activity programs could improve the severity of depression in this population.

Exercise and Depressive Disorder

Depression is a psychiatric disorder characterized by low mood, loss of interest/enjoyment, and reduced energy and one of the five leading causes of disability and a major contributor to all-cause mortality worldwide. People with depression have, between others, a reduced life expectancy, worse quality of life and cardiorespiratory fitness, and increased risk of type 2 diabetes, compared to the general population. Furthermore, the economic burden of mental disorders including depression is evident, and it is expected to increase to more than double by 2030. Therefore, reducing the growing burden of mental disorders such as depression should be a health priority. Improved prevention and treatment are two key factors that may reduce the burden of depression. Pharmacological- and psychotherapy-based interventions have been traditionally considered for treating depression disorders; however, there is an increasing amount of scientific evidence confirming that physical activity and physical exercise should be highly considered in prevention and treatment of depressive disorders. In this chapter, we aim to summarize and discuss the research progress of physical activity and exercise in prevention and treatment of depressive disorder. Specifically, we summarized and discussed the research progress of the prognostic use of physical activity for incident depression, the importance of sedentary behavior and other outcomes typically improved by physical activity/exercise such as cardiorespiratory fitness for future depression, the research progress of the evidence of the benefits of exercise in people with depression disorders, the resistance training effects in adults and older adults with depression, and the recommendations for the prescription of exercise for people with depression.

Physical Activity and Body Composition Are Associated With Severity and Risk of Depression, and Serum Lipids

BACKGROUND

Physical activity and a healthy body composition are said to reduce the risk of major depressive disorder. Nonetheless, deeper insight is needed into which specific forms of physical activity (and their relation to body composition) are effective in improving and preventing depressive symptoms.

METHODS

We compared different self-reported physical activities of the Global Physical Activity Questionnaire and body composition measures between patients with a current major depressive episode (MDE; N = 130) and healthy control subjects (N = 61). These parameters were also tested for correlations with depression severity and serum lipid levels in patients and controls.

RESULTS

Patients with a current MDE reported significantly fewer hours spent on total physical activity, walking or bicycling for travel, and vigorous-intensity activities at leisure than healthy control subjects. More time spent on vigorous-intensity activities at work, less time spent on walking or bicycling for travel, higher body fat mass, and lower body muscle mass correlated significantly with stronger depression severity. Physical activity and body measures correlated significantly with serum lipid levels.

LIMITATIONS

Self-reports of physical activity, only short-term follow-up of 20 days, cross-sectional study design without examination of causal role of exercise.

CONCLUSIONS

More time spent on traveling by foot or by bike is especially associated with a lower risk of and milder depression. These results highlight the differential role of physical activity in depression.

The role of exercise in brain DNA damage

Cells are constantly subjected to cytotoxic and genotoxic insults resulting in the accumulation of unrepaired damaged DNA, which leads to neuronal death. In this way, DNA damage has been implicated in the pathogenesis of neurological disorders, cancer, and aging. Lifestyle factors, such as physical exercise, are neuroprotective and increase brain function by improving cognition, learning, and memory, in addition to regulating the cellular redox milieu. Several mechanisms are associated with the effects of exercise in the brain, such as reduced production of oxidants, up-regulation of antioxidant capacity, and a consequent decrease in nuclear DNA damage. Furthermore, physical exercise is a potential strategy for further DNA damage repair. However, the neuroplasticity molecules that respond to different aspects of physical exercise remain unknown. In this review, we discuss the influence of exercise on DNA damage and adjacent mechanisms in the brain. We discuss the results of several studies that focus on the effects of physical exercise on brain DNA damage.

Effects of exergames and resistance training on well-being in older adults: a randomized clinical trial

OBJECTIVE: To analyze the effects of an exergame-based training compared to resistance training on the quality of life and symptoms of depression in older adults. METHODS: This was a two-arm, non-blinded, randomized clinical trial. Thirty-five participants (62.09 ± 7.11 years) were randomized either on the Exergame-based Training Group (n = 17) or the Resistance Training Group (n = 18). Sessions lasted 50 to 60 minutes, three times per week, for 13 weeks. For the Exergame-based Training Group, we used games that simulate sports and adventure activities through Xbox360 Kinect™. The Resistance Training Group performed ten exercises per session for upper and lower limbs using free weights and machines, following linear periodization and individualized loads. Quality of life and symptoms of depression were assessed using the World Health Organization Quality of Life assessment - an abbreviated version (WHOQOL-BREF) and the Geriatric Depression Scale, respectively. We performed a two-way analysis of variance (p ≤ 0.05). RESULTS: Only time effects were identified for overall quality of life, general health, and symptoms of depression. After the intervention, overall quality of life score increased (3.82 ± 0.95 versus 4.18 ± 0.53, p = 0.05), whereas symptoms of depression decreased (3.35 ± 1.73 versus 2.59 ± 1.54, p = 0.02) in the Exergame-based Training Group, and the general health improved in the Resistance Training Group (3.78 ± 0.81 versus 4.11 ± 0.68, p = 0.05) compared with the baseline scores. CONCLUSION: Both training groups improved different aspects of quality of life. The Exergaming-based Training Group improved the overall perception, whereas the Resistance Training Group improved the general health-related perception. Participants in the Exergame-based Training Group also decreased the number of symptoms of depression.

Feasibility and Acceptability of a Student-Led Lifestyle (Diet and Exercise) Intervention Within a Residential Rehabilitation Setting for People With Severe Mental Illness, GO HEART (Group Occupation, Health, Exercise And Rehabilitation Treatment)

PURPOSE

People with severe mental illness (SMI) experience poor physical health and premature mortality, contributed significantly by modifiable lifestyle risk factors such as poor nutrition, low cardiorespiratory fitness, and physical inactivity. Lifestyle interventions can reduce cardiometabolic risk and confer a range of other positive mental and physical health benefits. We assessed the feasibility, acceptability, safety, and preliminary effectiveness of a lifestyle (combined dietary and exercise) intervention lead by senior exercise and dietetics students in a residential mental health rehabilitation setting.

DESIGN

Single arm, prospective study evaluating outcomes pre and post a 10-week dietary and exercise intervention.

METHOD

People with SMI from three residential rehabilitation units participated in a mixed aerobic and resistance training exercise intervention three times per week that was combined with a dietary intervention (six individual and group sessions). Primary outcome considerations were feasibility (recruitment, retention, and participation rates), acceptability, and adverse events. Secondary outcomes were preliminary effectiveness; (functional exercise capacity, volume of exercise, and metabolic markers), psychiatric symptoms, quality of life, and attitudes to exercise.

RESULTS

Forty-two participants were recruited (92% primary diagnosis of schizophrenia). Intervention feasibility was supported by high levels of recruitment (68%), retention (77%), and participation (70% exercise, 65% diet sessions); and the absence of serious adverse events. Significant improvements in functional exercise capacity, volume of exercise, general psychiatric symptoms, and negative psychotic symptoms occurred. Anthropometric and metabolic blood markers did not change. While the intervention was acceptable to participants, motivation for and perceived value of exercise reduced over 10 weeks.

CONCLUSIONS

A brief pragmatic student-led lifestyle intervention integrated into usual mental health care was feasible, acceptable, safe, and scalable across two additional mental health residential rehabilitation sites, and resulted in physical and mental health improvements. Increased frequency of dietary sessions and length of dietary intervention may improve metabolic outcomes in the future. People with SMI living in residential rehabilitation units should have access to lifestyle programs to address modifiable lifestyle risk factors. While this brief intervention was feasible and acceptable, this study highlights some of the challenges associated with maintaining motivation for healthy lifestyles for people with SMI. Longer term investigation of real-world lifestyle interventions is warranted, together with additional interventions that may support people with SMI to sustain motivation to address lifestyle factors.

CLINICAL TRIAL REGISTRATION

The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), Unique Identifier: ACTRN 12618000478213, http://www.anzctr.org.au Universal trial number (UTN)-U1111-1211-4009.

Feasibility of Resistance Exercise for Posttraumatic Stress and Anxiety Symptoms: A Randomized Controlled Pilot Study

Emerging evidence suggests that exercise may beneficially affect posttraumatic stress symptoms (PTSS), but few randomized trials exist. Additionally, the effects of resistance exercise (i.e., weight lifting or strength training) on PTSS have not been thoroughly examined. This study aimed to explore the feasibility of a brief high-intensity resistance exercise intervention for PTSS and related issues, such as anxiety, sleep, alcohol use, and depression, in non-treatment-seeking adults who screened positive for posttraumatic stress disorder (PTSD) and anxiety. The sample included 30 non-treatment-seeking, urban-dwelling adults (M age = 29.10 years, SD = 7.38; 73.3% female) who screened positive for PTSD and anxiety and were randomly assigned to either a 3-week resistance exercise intervention or a time-matched contact control condition. The results suggest the intervention was feasible, with 80.0% (n = 24) of participants completing the study, 88.9% of the resistance exercise sessions attended, and no adverse effects reported. Additionally, resistance exercise had large beneficial effects on symptoms of avoidance, d = 1.26, 95% CI [0.39, 2.14]; and hyperarousal, d = 0.90, 95% CI [0.06, 1.74], relative to the control condition. Resistance exercise also produced large improvements concerning sleep quality, d = 1.31, 95% CI [0.41, 2.21], and hazardous alcohol use, d = 0.99, 95% CI [0.13, 1.86], compared to the control condition. Overall, the findings suggest that 3 weeks of high-intensity resistance exercise is a feasible intervention for PTSS reduction in non-treatment-seeking adults who screen positive for PTSD and anxiety; additional research is needed to verify these preliminary findings.

Differential treatment effects of an integrated motivational interviewing and exercise intervention on depressive symptom profiles and associated factors: A randomised controlled cross-over trial among youth with major depression

BACKGROUND

Exercise is increasingly recognised as an efficacious intervention for major depressive disorder (MDD) but to our knowledge differential treatment effects on depressive symptom profiles (cognitive, somatic and affective) and associated changes in psychological, physiological and behavioural factors have not been examined among youth with MDD.

METHODS

Sixty-eight participants (mean age 20.8) meeting DSM-IV diagnostic criteria for MDD were randomised to an Immediate intervention or Control/delayed condition (n = 34 per group). The integrated intervention comprised an initial session of motivational interviewing (MI) followed by a 12-week, multi-modal exercise program. Changes in depressive symptom profiles were assessed with the Beck Depression Inventory-II (BDI-II) total score and factorial symptom subscales.

RESULTS

There were significant differential improvements in BDI-II total scores post-treatment among intervention participants, which were also observed across the cognitive and affective subscales. Individual BDI-II items from the cognitive subscale showing significant differential improvement related to negative self-concept, while those from the affective subscale related to interest/activation; the energy item within the somatic subscale also revealed significant differential improvement. Significant differential improvements were also observed in exercise participation, negative automatic thoughts, behavioural activation and bench press repetitions among intervention participants, which correlated significantly with depression improvements.

LIMITATIONS

The exercise intervention was delivered in a supervised, group format and potential social meditators of change cannot be excluded.

CONCLUSIONS

Exercise differentially effects depressive symptom profiles with similar antidepressant effects as would be expected from psychological therapies improving negative cognition and emotional health.

Depressive Symptoms, Lack of Physical Activity, and Their Combination Towards Health Care Utilisation Frequency

Depressive symptoms and lack of physical activity are independent factors that lead to higher health care utilisation, often occurring simultaneously. We aimed to assess the effects of depressive symptoms, lack of aerobic physical activity (PA), and the combination of those factors on the probability of using in- and outpatient health care services in men and women. Data from 15,770 people from the nationally representative Austrian Health Interview Survey (AT-HIS) were used. In analysis, depressive symptoms, adjusted for sociodemographic, health related, and lifestyle-related factors were associated with higher odds of outpatient health care utilisation (OR: 1.60; 95% CI: 1.19–2.14) in men and (OR: 2.10; 95%CI: 1.65–2.66) in women, and with higher odds of inpatient health care utilisation (OR: 1.52; 95% CI: 1.09–2.10) in men and (OR: 2.09; 95% CI: 1.64–2.68) in women. However, depressive symptoms were not associated with higher health care utilisation in the fully adjusted models. In men, co-existence of depressive symptoms and lack of health enhancing physical activity (HEPA) was associated with higher odds of using inpatient health care services, compared to the presence of only one or none of the factors. In conclusion, our results show that depressive symptoms are associated with more health care utilisation in both men and women and that the co-existence of both depressive symptoms and lack of HEPA elevated the odds for inpatient health care utilisation in men even more.

Effect of exercise referral schemes upon health and well-being: initial observational insights using individual patient data meta-analysis from the National Referral Database

Objectives

To examine if exercise referral schemes (ERSs) are associated with meaningful changes in health and well-being in a large cohort of individuals throughout England, Scotland, and Wales from the National Referral Database.

Methods

Data were obtained from 23 731 participants from 13 different ERSs lasting 6 weeks to 3 months. Changes from pre- to post-ERS in health and well-being outcomes were examined including body mass index (BMI), blood pressure (systolic (SBP) and diastolic (DBP)), resting heart rate (RHR), short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS), WHO Well-Being Index (WHO-5), Exercise Related Quality of Life scale (ERQoL), and Exercise Self-Efficacy Scale (ESES). Two-stage individual patient data meta-analysis was used to generate effect estimates.

Results

Estimates (95% CIs) revealed statistically significant changes occurred compared with point nulls for BMI (−0.55 kg.m2 (−0.69 to −0.41)), SBP (−2.95 mmHg (−3.97 to −1.92)), SWEMWBS (2.99 pts (1.61 to 4.36)), WHO-5 (8.78 pts (6.84 to 10.63)), ERQoL (15.26 pts (4.71 to 25.82)), and ESES (2.58 pts (1.76 to 3.40)), but not RHR (0.22 fc (−1.57 to 1.12)) or DBP (−0.93 mmHg (−1.51 to −0.35)). However, comparisons of estimates (95% CIs) against null intervals suggested the majority of outcomes may not improve meaningfully.

Conclusions

We considered whether meaningful health and well-being changes occur in people who are undergoing ERSs. These results demonstrate that, although many health and well-being outcomes improved, the changes did not achieve meaningful levels. This suggests the need to consider the implementation of ERSs more critically to discern how to maximise their effectiveness.

Effects of resistance training on depression and cardiovascular disease risk in Black men: Protocol for a randomized controlled trial

BACKGROUND

Depression is severely undertreated in Black men. This is primarily because Black men are less likely to seek traditional psychiatric treatment, have less access and more barriers to treatment, and perceive more stigma associated with treatment. Depression contributes to cardiovascular disease (CVD), and Black men have the highest rate of mortality from CVD. Resistance training (RT) can have beneficial effects on both depression and CVD. This study will be the first randomized controlled trial to test the effects of RT on depression and cardiovascular health in a sample of depressed Black men.

METHOD/DESIGN

Fifty Black men with clinically significant symptoms of depression will be randomized to either (a) a 12-week RT or (b) an attention-control group. Behavioral Activation techniques will be used to support adherence to home-based RT goals. Both groups will meet on-site twice/week during the 12-week program, and follow-up assessments will occur at the end-of-treatment and 3 months post-treatment. Qualitative interviews will be conducted after the 3-month follow-up. The objectives of this study are (1) to assess the feasibility and acceptability of recruitment, retention, and intervention procedures, (2) to obtain preliminary evidence of efficacy, and (3) to explore potential mediators of the effects of RT on depression.

DISCUSSION

This study will advance the field of minority men's health by producing new data on the effects of RT for depression, the potential mechanisms of action that may support its use, and its effects on markers of CVD risk in Black men.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT03107039).

Resistance training in addition to aerobic activity is associated with lower likelihood of depression and comorbid depression and anxiety symptoms: A cross sectional analysis of Australian women

The mental health benefits of resistance training (RT) alone or beyond those provided by aerobic physical activity (PA) are unclear. This study aimed to determine the association between meeting recommendations for aerobic PA and/or RT, and symptoms of depression and/or anxiety. Participants were Australian female members of the 10,000 Steps project (n = 5180, 50.0 ± 11.5 years). Symptoms of depression and anxiety were determined using the Depression Anxiety Stress Score. Participants were grouped as 'depression only', 'anxiety only', 'co-occurring depression and anxiety' or 'neither depression nor anxiety' based on relevant subscale score (cut-points: depression≥14 points, anxiety≥10 points). The International Physical Activity Questionnaire-Long Form questionnaire was used to determine PA with an additional item to specify RT frequency. Participants were classified as adhering to 'aerobic PA only' (≥150 min PA/week), 'RT only' (RT ≥ 2 days/week), 'aerobic PA + RT' (≥150 min PA/week+RT ≥ 2 days/week), or 'neither aerobic PA nor RT' (<150 min PA/week+RT < 2 days/week). Adjusted relative risk ratios (RRR [95%CI]) were estimated using multinomial logistic regression models. Relative to the 'neither PA nor RT' (n = 2215), the probabilities of 'depression only' (n = 317) and 'co-occurring depression and anxiety' (n = 417) were lower for the 'aerobic PA only' (n = 1590) (RRR = 0.74 [0.56-0.97] and RRR = 0.76 [0.59-0.97] respectively), and 'both PA + RT' (n = 974) groups (RRR = 0.61 [0.43-0.86] and RRR = 0.47 [0.33-0.67] respectively). There were no associations between adhering to one or both recommendations and 'anxiety only' (n = 317), or between 'RT only' (n = 401) and depression and/or anxiety. Prevention and treatment strategies including both aerobic PA and RT may provide additional benefits for depression with or without comorbid anxiety.

The evidence for physical activity in the management of major mental illnesses: a concise overview to inform busy clinicians' practice and guide policy

PURPOSE OF REVIEW

Physical activity has established the efficacy in improving physical health, mental health and cognition in the general population. Recent research has examined its potential as a preventive measure and/or adjunctive treatment for various mental health conditions. This review summarizes the recent evidence for physical activity in the management of major mental illnesses.

RECENT FINDINGS

Emerging evidence suggests that physical activity may confer protection against depression and anxiety/stress disorders. There is robust evidence that structured and supervised physical activity, including aerobic and resistance training, can improve multiple outcomes in major depression, pre/postnatal depression, anxiety/stress disorders and schizophrenia. Emerging evidence suggests a potential role for physical activity in bipolar disorder and alcohol use disorders.

SUMMARY

The quantity and quality of evidence regarding the efficacy of physical activity for mental illnesses is increasing. Given the established and further potential benefits and low adverse risk profile, physical activity should be offered as an adjunctive part of core mental health treatment. However, there is a need for high-quality multisite randomized controlled trials that can be replicated in routine care in mental health services. Future population-level trials are needed to examine the potential use of physical activity in those at risk of mental health conditions to see if physical activity can prevent the development of mental disorders.

Differences in college students' aerobic physical activity and muscle-strengthening activities based on gender, race, and sexual orientation

Aerobic physical activity and muscle-strengthening activities are beneficial to both physical and mental health, though disparities in these behaviors exist based on social determinants. The purpose of this study was to examine differences in college students' aerobic physical activity and muscle-strengthening activities based on gender, race, and sexual orientation. Undergraduates enrolled in general education health and wellness courses at a large northeastern University in the United States responded to an online survey in August 2018 that assessed their demographics and physical activity behaviors. Differences in physical activity behaviors based on social determinants were examined using independent-samples t-tests and chi-square tests for independence. Less than half (40.3%) of participants (n = 606) met both aerobic physical activity and muscle-strengthening recommendations. No differences were found in physical activity based on sexual orientation. However, significantly more non-Hispanic white participants met aerobic physical activity (74.4% vs. 63.8%) and muscle-strengthening recommendations (47.2% vs. 37.6%); and, men reported significantly greater vigorous physical activity (p = .034, η² = 0.01) and participation in muscle-strengthening activities (p < .001, η² = 0.06), and were more likely to meet muscle-strengthening recommendations compared to women (50.8% vs. 41.4%). Findings demonstrate disparities in physical activity based on race and sex, particularly with respect to muscle-strengthening activities. Findings are of concern given the importance of muscle-strengthening activities to both physical and mental health. Colleges should consider ways in which they can facilitate increased participation of racial/ethnic minorities and women in muscle-strengthening activities.

Exercise, spinogenesis and cognitive functions

Exercise training improves mental and cognitive functions by enhancing neurogenesis and neuroprotection. Recent studies suggest the facilitation of spinogenesis across different brain regions including hippocampus and cerebral cortex by physical activity. In this article we will summarize major findings for exercise effects on synaptogenesis and spinogenesis, in order to provide mechanisms for exercise intervention of both psychiatric diseases and neurodegenerative disorders. We will also revisit major findings for molecular mechanism governing exercise-related spinogenesis, and will discuss the screening for novel factors, or exerkines, whose levels are correlated with endurance training and affect neural plasticity. We believe that further studies focusing on the molecular mechanism of exercise-mediate spinogenesis should benefit the optimization of exercise therapy in clinics and the evaluation of treatment efficiency using specific biomarkers.

Associations between grip strength and generalized anxiety disorder in older adults: Results from the Irish longitudinal study on ageing

BACKGROUND

Associations between grip strength and mental health disorders have been established; however, associations between grip strength and Generalized Anxiety Disorder (GAD) remain unstudied. Therefore, this study investigates associations between grip strength and prevalent and incident GAD.

METHODS

A prospective cohort design was utilized. At baseline, participants aged ≥50 years (N = 3,952) completed a hand grip strength assessment and abbreviated Penn State Worry Questionnaire (PSWQ) and were divided into sex-specific tertiles based on strength. A score of ≥23 on the PSWQ defined caseness of GAD. At two-year follow-up, GAD was assessed with the Composite International Diagnostic Interview-Short Form.

RESULTS

Prevalence and incidence of GAD were 18.2% (N = 718) and 0.9% (N = 29), respectively. Adjusting for age, sex, waist circumference, social class, smoking status, and physical activity, a one-standard-deviation (1-SD) increase in strength was associated (OR, 95%CI) with 12.1% (OR = 0.88, 0.80-0.96; p < 0.01) lower odds of prevalent GAD, and middle and high strength tertiles were associated with 27.3% (OR = 0.73, 0.59-0.89; p < 0.01) and 23.1% (OR = 0.77, 0.62-0.95; p < 0.05) lower odds, respectively. A 1-SD increase in strength was non-significantly associated with 24.2% (OR = 0.76, 0.50-1.14) lower odds of incident GAD, and middle and high strength tertiles were non-significantly associated with 31.4% (OR = 0.69, 0.30-1.58) and 66.5% (OR = 0.34, 0.11-1.00) lower odds, respectively (all p > 0.05). There was no significant interaction between strength tertiles and sex.

LIMITATIONS

The observational nature of the study limits inferring causality.

CONCLUSIONS

Increased hand grip strength may be associated with lower odds of developing GAD in older adults. Larger investigations of prospective associations are needed.

General strength and conditioning versus motor control with manual therapy for improving depressive symptoms in chronic low back pain: A randomised feasibility trial

Objectives

Exercise can be used as a treatment for depressive symptoms in the general population. However, little is known as to whether exercise has mental health benefits for adults experiencing chronic low back pain (CLBP). The aim of this study was to examine the feasibility of two intervention protocols commonly used in clinical practice for treating chronic low back pain, but with differing exercise dose, on depressive symptoms.

Methods

Forty men and women (mean age = 35) experiencing chronic persistent (>3 months), non-specific low back pain were recruited into a randomised clinical trial during 2015–2016. Participants were randomised to receive motor control (low-dose exercise) and manual therapy (n = 20), or general strength and conditioning training (moderate-dose exercise) (n = 20). Depressive symptoms were assessed fortnightly throughout a 6-month follow-up period using the Centre for Epidemiologic Studies Depression Scale (CES-D 10). Linear mixed models were used to examine within-group and between-group changes in depressive symptoms.

Results

Mean CES-D 10 score at baseline was 9.17 (SD = 4.32). There was evidence of a small decrease in average depressive symptoms over time (β -0.19 per fortnight, 95% CI = -0.34, -0.02). However, there was no evidence that change over time was dependent on treatment group.

Conclusions

Reduction in depressive symptoms amongst adults with CLBP occurred with both treatment methods (motor control [low-dose exercise] and manual therapy; or general strength and conditioning [moderate-dose exercise]). Further interventions including a true control group are needed to draw conclusions as to the effectiveness of each of these treatment methods on depressive symptoms amongst adults with CLBP.

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN12615001270505. Registered on 20 November 2015.

Evidence-Based, High-Intensity Exercise and Physical Activity for Compressing Morbidity in Older Adults: A Narrative Review

Recent research in exercise science has important applications for middle-aged and older adults and points to how the programming of individual and multicomponent interventions including theory-based health behavior change strategies may be improved to compress morbidity by delaying or reducing the disabling process. High-intensity interval training and sprint interval training until recently were seen as only applicable to athletes. But recent lab-based research has adapted these interventions for even older adults and demonstrated their safety with beneficial outcomes on cardiometabolic risk factors comparable to or surpassing the usual lower- to moderate-intensity endurance training, and their potential translatability by showing the efficacy of much lower duration and frequency of training, even by systematic stair climbing. Moreover, people report positive affect while engaged in such training. For a century, resistance training was conceived as weightlifting with heavy weights required. Recent research has shown that using a higher degree of effort with lighter to moderate resistance in simple, time efficient protocols result in gains in strength and muscle mass similar to heavy resistance, as well as improvement of cardiometabolic risk factors, strength, body composition, and cognitive, affective, and functional abilities. More effort-based resistance training with moderate resistance may make resistance training more appealing and accessible to older adults. A key potential translational finding is that with correct technique and a high degree of effort, training with inexpensive, portable elastic bands, useable virtually anywhere, can provide appreciable benefits. More emphasis should be placed on long-term, translational interventions, resources, and programs that integrate interval and resistance trainings. This work may improve public health programs for middle-aged and older adults and reflects an emerging evidence base.

Physical activity and muscle-brain crosstalk

Neurological and mental illnesses account for a considerable proportion of the global burden of disease. Exercise has many beneficial effects on brain health, contributing to decreased risks of dementia, depression and stress, and it has a role in restoring and maintaining cognitive function and metabolic control. The fact that exercise is sensed by the brain suggests that muscle-induced peripheral factors enable direct crosstalk between muscle and brain function. Muscle secretes myokines that contribute to the regulation of hippocampal function. Evidence is accumulating that the myokine cathepsin B passes through the blood-brain barrier to enhance brain-derived neurotrophic factor production and hence neurogenesis, memory and learning. Exercise increases neuronal gene expression of FNDC5 (which encodes the PGC1α-dependent myokine FNDC5), which can likewise contribute to increased brain-derived neurotrophic factor levels. Serum levels of the prototype myokine, IL-6, increase with exercise and might contribute to the suppression of central mechanisms of feeding. Exercise also increases the PGC1α-dependent muscular expression of kynurenine aminotransferase enzymes, which induces a beneficial shift in the balance between the neurotoxic kynurenine and the neuroprotective kynurenic acid, thereby reducing depression-like symptoms. Myokine signalling, other muscular factors and exercise-induced hepatokines and adipokines are implicated in mediating the exercise-induced beneficial impact on neurogenesis, cognitive function, appetite and metabolism, thus supporting the existence of a muscle-brain endocrine loop.

Physical activity correlates among older adults with probable generalized anxiety disorder: Results from The Irish Longitudinal Study on Ageing

OBJECTIVES

This study assessed physical activity (PA) correlates among 1237 (69.0% female; age ≥ 50 years) community-dwelling adults with probable-generalized anxiety disorder (GAD).

METHODS

Wave 1 data from The Irish Longitudinal Study on Ageing were analysed. PA was measured using the short-form International PA Questionnaire. Probable-GAD caseness was indicated by a score of ≥23 on the abbreviated Penn State Worry Questionnaire. Potential correlates were analysed using binomial logistic regression. Hierarchical logistic regression consisting of three blocks (sociodemographic variables; quality of life (QoL) variables; physical health and performance variables) examined the proportion of the variance for PA that was explained at each step of the regression model.

RESULTS

Five hundred thirty-five participants (43.2%) met PA guidelines. After adjustment for age and sex, younger age and being male were associated with increased likelihood of meeting PA guidelines. Significant correlates of PA were in employment, higher QoL (CASP-19), social connectedness, and grip-strength. Additionally, polypharmacy (i.e., taking ≥five medications), antidepressant use, at-risk waist circumference (i.e., Males: >94 cm; Females >80 cm), up-and-go time, and number of self-reported physical limitations were significantly negatively associated with meeting PA guidelines. Physical health and performance variables explained significant variation (8.4%) in meeting physical activity guidelines beyond that of sociodemographics, and QoL variables.

CONCLUSIONS

This study identified a range of sociodemographic, physical, and psychological variables that were associated with meeting or not meeting PA guidelines among older adults with probable-GAD.

Involvement in Sports, Hippocampal Volume, and Depressive Symptoms in Children

BACKGROUND

Recent studies have found that higher levels of exercise are associated with fewer symptoms of depression among young people. In addition, research suggests that exercise may modify hippocampal volume, a brain region that has been found to show reduced volume in depression. However, it is not clear whether this relationship emerges as early as preadolescence.

METHODS

We examined data from a nationwide sample of 4191 children 9 to 11 years of age from the Adolescent Brain and Cognitive Development Study. The parents of the children completed the Child Behavior Checklist, providing data about the child's depressive symptoms, and the Sports and Activities Questionnaire, which provided data about the child's participation in 23 sports. Children also took part in a structural magnetic resonance imaging scan, providing us with measures of bilateral hippocampal volume.

RESULTS

Sports involvement interacted with sex to predict depressive symptoms, with a negative relationship found in boys only (t = -5.257, β = -.115, p < .001). Sports involvement was positively correlated with hippocampal volume in both boys and girls (t = 2.810, β = .035, p = .007). Hippocampal volume also interacted with sex to predict depressive symptoms, with a negative relationship in boys (t = -2.562, β = -.070, p = .010), and served as a partial mediator for the relationship between involvement in sports and depressive symptoms in boys.

CONCLUSIONS

These findings help illuminate a potential neural mechanism for the impact of exercise on the developing brain, and the differential effects in boys versus girls mirror findings in the animal literature. More research is needed to understand the causal relationships between these constructs.

Lower resting cardiac autonomic balance in young adults with current major depression

Research on cardiac autonomic function in major depressive disorder (MDD) has predominantly examined cardiac vagal control and adopted a model of reciprocal autonomic balance. A proposed bivariate autonomic continuum uses cardiac autonomic balance (CAB) and cardiac autonomic regulation (CAR) models, derived from normalized values of respiratory sinus arrhythmia and pre-ejection period, to more adequately index patterns of autonomic control. The purpose of this study was to assess resting levels of CAB and CAR among young adults with and without a current diagnosis of major depression. One hundred forty-two young adults (n = 65 MDD, n = 77 healthy controls; 20.8 ± 2.6 years) completed a structured diagnostic interview, cardiovascular assessment, and a maximal aerobic fitness test. The findings revealed that CAB, but not CAR, significantly predicted current MDD status (OR = 0.70, 95% CI [0.53, 0.93]), an effect that remained after controlling for aerobic fitness and body mass index. Although CAB was found to be a significant predictor of current MDD status among a sample of young adults, there remained substantial variation in autonomic control that was not captured by the traditional model of reciprocal autonomic balance.

Assessment of Bidirectional Relationships Between Physical Activity and Depression Among Adults: A 2-Sample Mendelian Randomization Study

Importance

Increasing evidence shows that physical activity is associated with reduced risk for depression, pointing to a potential modifiable target for prevention. However, the causality and direction of this association are not clear; physical activity may protect against depression, and/or depression may result in decreased physical activity.

Objective

To examine bidirectional relationships between physical activity and depression using a genetically informed method for assessing potential causal inference.

Design, Setting, and Participants

This 2-sample mendelian randomization (MR) used independent top genetic variants associated with 2 physical activity phenotypes-self-reported (n = 377 234) and objective accelerometer-based (n = 91 084)-and with major depressive disorder (MDD) (n = 143 265) as genetic instruments from the largest available, nonoverlapping genome-wide association studies (GWAS). GWAS were previously conducted in diverse observational cohorts, including the UK Biobank (for physical activity) and participating studies in the Psychiatric Genomics Consortium (for MDD) among adults of European ancestry. Mendelian randomization estimates from each genetic instrument were combined using inverse variance weighted meta-analysis, with alternate methods (eg, weighted median, MR Egger, MR-Pleiotropy Residual Sum and Outlier [PRESSO]) and multiple sensitivity analyses to assess horizontal pleiotropy and remove outliers. Data were analyzed from May 10 through July 31, 2018.

Main Outcomes and Measures

MDD and physical activity.

Results

GWAS summary data were available for a combined sample size of 611 583 adult participants. Mendelian randomization evidence suggested a protective relationship between accelerometer-based activity and MDD (odds ratio [OR], 0.74 for MDD per 1-SD increase in mean acceleration; 95% CI, 0.59-0.92; P = .006). In contrast, there was no statistically significant relationship between MDD and accelerometer-based activity (β = -0.08 in mean acceleration per MDD vs control status; 95% CI, -0.47 to 0.32; P = .70). Furthermore, there was no significant relationship between self-reported activity and MDD (OR, 1.28 for MDD per 1-SD increase in metabolic-equivalent minutes of reported moderate-to-vigorous activity; 95% CI, 0.57-3.37; P = .48), or between MDD and self-reported activity (β = 0.02 per MDD in standardized metabolic-equivalent minutes of reported moderate-to-vigorous activity per MDD vs control status; 95% CI, -0.008 to 0.05; P = .15).

Conclusions and Relevance

Using genetic instruments identified from large-scale GWAS, robust evidence supports a protective relationship between objectively assessed-but not self-reported-physical activity and the risk for MDD. Findings point to the importance of objective measurement of physical activity in epidemiologic studies of mental health and support the hypothesis that enhancing physical activity may be an effective prevention strategy for depression.

Associations between aerobic and muscle-strengthening exercise with depressive symptom severity among 17,839 U.S. adults

For the prevention and management of chronic diseases, global physical activity guidelines state that an adult should engage in regular moderate-to-vigorous aerobic physical activity (MVPA; e.g. walking, cycling, running) and muscle-strengthening exercise (MSE; e.g. strength/resistance training). However, the associations between combined MVPA-MSE with chronic health conditions are rarely examined in large population studies. In particular, little is known associations between combined MVPA-MSE with depressive disorders, one of the leading causes of disability worldwide. The aim of this study is to describe the associations between MVPA and MSE with depressive symptom severity among a large sample of U.S. adults. Data were drawn from the U.S. 2015 Behavioral Risk Factor Surveillance System. During phone interviews, MVPA, MSE and depressive symptom severity were assessed by validated questionnaires. Poisson regression with a robust error or variance were used to assess prevalence ratios (PR) of depressive symptom severity (mild, moderate, moderately severe/severe) across categories of physical activity guideline adherence (met neither [reference]; MSE only; MVPA only; met both), adjusting for a set of potential cofounders. Data were available on 17,839 adults (18-85 years). When compared with those meeting neither guideline, for mild, moderate and moderately severe/severe depressive symptoms, the PRs were lowest among meeting both guidelines (range: 0.26-0.54), followed by MVPA only (range: 0.36-0.62) and MSE only (range: 0.49-0.84). Among a large sample of U.S. adults, compared to other guideline adherence categories, meeting both MVPA-MSE guidelines was associated with a lowest likelihood of reporting depressive symptoms.

Examining a training effect on the state anxiety response to an acute bout of exercise in low and high anxious individuals

BACKGROUND

An acute bout of exercise temporarily reduces state anxiety. The current study examined whether these benefits are greater for those with higher levels of anxiety, and whether these benefits are augmented with exercise training.

METHODS

Young adults were randomized to either a nine-week moderate-intensity exercise group or an inactive control group. We assessed changes in state anxiety in response to an acute bout of exercise each week.

RESULTS

State anxiety reductions following acute exercise increased in the exercise subgroup with high anxiety at baseline as training progressed (p = .029). No training effects were observed for the exercise subgroup with low baseline anxiety (p = .27).

LIMITATIONS

A predominantly female sample, a single state anxiety measure post exercise and a non-exercise control group should be addressed in future research.

CONCLUSIONS

The results support the use of regular physical activity as a method for managing state anxiety in young adults. In particular, regular physical activity may be especially beneficial for those experiencing higher levels of anxiety.

Physical activity is indirectly associated with pain in college women through associations with somatization and panic disorder symptoms: a cross-sectional study

PURPOSE

This study tested whether the severity of somatization, panic, generalized anxiety, and depression symptoms mediated relationships between physical activity and pain using structural equation modeling.

METHODS

College women (n = 1036; mean = SD age of 19.7 ± 3.0 years) reported past week physical activity and the presence of persistent pain (≥1 month). The Psychiatric Diagnostic Screening Questionnaire assessed hypothesized mediators of physical activity effects on pain via symptoms of generalized anxiety, panic, major depressive disorder, and somatization disorder.

RESULTS

The percentage of the sample screening positive was 15.7% for generalized anxiety, 5.8% for panic, 11.0% for major depressive, and 16.0% for somatization. The hypothesized model had good fit and accounted for a significant amount of variance in pain (9.1%). Direct paths from physical activity to somatization, generalized anxiety, major depressive disorder, and panic disorder were significant. Paths to pain were significant from somatization and panic disorder. The path from physical activity to pain was not direct but indirect and through significant paths to pain from somatization and panic disorder. Each standard deviation increase in physical activity decreased the probability of pain by 11.0% through panic disorder and 10.7% through somatization disorder.

CONCLUSIONS

Physical activity is associated with pain indirectly through associations with panic disorder and somatization disorder symptoms in college women.

Inmates with Harmful Substance Use Increase Both Exercise and Nicotine Use Under Incarceration

Exercise is increasingly understood as an important resource for people who engage in harmful substance use, including those in prison. Little is known about how inmates adopt various health behaviors during incarceration, without interventions. This cross-sectional study analyzed self-reports from 1464 inmates in Norwegian prisons in 2013–2014, compared them according to harmful substance use pre-incarceration, and explored changes in exercise and nicotine use during incarceration. Results were presented in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Inmates with harmful substance use reported higher rates of smoking, smokeless tobacco, and physical inactivity pre-incarceration than inmates without harmful use. However, inmates with harmful use also exhibited more behavioral changes: they adopted exercise, ceased smoking, and adopted smokeless tobacco at higher rates during incarceration than the non-harmful group, to the extent that inmates with harmful use exercised during incarceration more. Exercise is being taken up by a significant proportion of inmates, and may in particular be a replacement behavior for substance use. However, unhealthy behaviors also begin or are maintained. If prisons were used as an arena to facilitate healthy behaviors, the public health benefits to a marginalized group such as substance-using inmates could be substantial.

Associations of self-reported physical activity and depression in 10,000 Irish adults across harmonised datasets: a DEDIPAC-study

BACKGROUND

Depression is a prevalent, debilitating, and often recurrent mood disorder for which successful first-line treatments remains limited. The purpose of this study was to investigate the cross-sectional associations between self-reported physical activity (PA) and depressive symptoms and status among Irish adults, using two existing datasets, The Irish Longitudinal Study on Ageing (TILDA) and The Mitchelstown Cohort Study.

METHODS

The two selected databases were pooled (n = 10,122), and relevant variables were harmonized. PA was measured using the short form International Physical Activity Questionnaire. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression (CES-D) questionnaire. Participants were classified as meeting World Health Organization moderate-to-vigorous PA (MVPA) guidelines or not, and divided into tertiles based on weekly minutes of MVPA. A CES-D score of ≥16 indicated elevated depressive symptoms. Data collection were conducted in 2010-2011.

RESULTS

Significantly higher depressive symptoms were reported by females (7.11 ± 7.87) than males (5.74 ± 6.86; p < 0.001). Following adjustment for age, sex, BMI, and dataset, meeting the PA guidelines was associated with 44.7% (95%CI: 35.0 to 52.9; p < 0.001) lower odds of elevated depressive symptoms. Compared to the low PA tertile, the middle and high PA tertiles were associated with 25.2% (95%CI: 8.7 to 38.6; p < 0.01) and 50.8% (95%CI: 40.7 to 59.2; p < 0.001) lower odds of elevated depressive symptoms, respectively.

CONCLUSION

Meeting the PA guidelines is associated with lower odds of elevated depressive symptoms, and increased volumes of MVPA are associated with lower odds of elevated depressive symptoms.