Physical activity and sedentary behavior in people with major depressive disorder: A systematic review and meta-analysis

Prison Unhealthy Lifestyle and Poor Mental Health of Older Persons-A Qualitative Study

Background: Mental healthcare and lifestyle habits in prison, especially for older individuals, has been shown to be suboptimal. Most psychiatric conditions left untreated worsen food choices, physical inactivity, and substance abuse. In turn, bad habits lead to poorer mental health. Methods: To comprehensively illustrate this downward spiraling, we completed a thorough analysis of data obtained through semi-structured qualitative interviews. There were 50 interviews of aging incarcerated people included in this article. They were analyzed following a classical six-stepped thematic analysis. Results: According to our participants, sports are not well-adapted to aging individuals, nor to people with medical conditions. Prison is even more unadapted for those who both are aging and have medical conditions. Also, food served is less than optimal. According to our interviews, the older imprisoned individual often does not have access to food adapted to his or her medical conditions. Sport is maladapted for older incarcerated individuals and mostly tailored for younger ones. Finally, boredom and lack of responsibility hinder change toward a better lifestyle for older adults in prison. Conclusion: Our paper shows why prison environmental modifications are needed to help older adults with their lifestyle habits. It also exposes an original way to see the relationship between mental health and lifestyle habits.

Prolonged Physical Inactivity in Older Adult Couples: A Dyadic Analysis Using Actigraphy

Background and Objectives

Many older adults remain inactive despite the known positive health implications of physical activity (improved mood, reduced mortality risk). Physical inactivity is an interdependent phenomenon in couples, but most research examines physical inactivity at the individual level. We estimated the average amount of prolonged physical inactivity for older adult couples and, using dyadic analysis, identified physical and mental health determinants thereof.

Research Design and Methods

Forty-six heterosexual older adult couples (age = 70.61 ± 6.56) from the Veterans Integrated Service Network 20 cohort of the Collaborative Aging Research using Technology (CART) initiative were included. The average number per day of prolonged inactive periods (no step counts or sleep activity for ≥30 min) was estimated using actigraphy data collected over a month.

Results

Multilevel modeling revealed that, within couples, there was no significant difference between partners in the average amount of inactive periods (p = .28). On average across couples, males and females had an average of 6.90 ± 2.02 and 6.56 ± 1.93 inactive periods per day, respectively. For males, older age was the only variable associated with more inactive periods (β = 0.15, p = .002). For females, having more depressive symptoms in both dyad members was associated with fewer inactive periods (female: β = −0.30, p = .03; male: β = −0.41, p < .001), and more dependence in completing their own instrumental activities of daily living predicted more inactive periods (β = 2.58, p < .001).

Discussion and Implications

Viewing couples’ activity as an interdependent phenomenon, rather than individual, provides a novel approach to identifying pathways to reduce inactivity in older adults, especially when focusing on the mental health and level of independence within the couple.

Accelerometer-derived sedentary time and physical activity and the incidence of depressive symptoms - The Maastricht Study

BACKGROUND

This study examined the associations between accelerometer-derived sedentary time (ST), lower intensity physical activity (LPA), higher intensity physical activity (HPA) and the incidence of depressive symptoms over 4 years of follow-up.

METHODS

We included 2082 participants from The Maastricht Study (mean ± s.d. age 60.1 ± 8.0 years; 51.2% men) without depressive symptoms at baseline. ST, LPA and HPA were measured with the ActivPAL3 activity monitor. Depressive symptoms were measured annually over 4 years of follow-up with the 9-item Patient Health Questionnaire (PHQ-9). Cox regression analysis was performed to examine the associations between ST, LPA, HPA and incident depressive symptoms (PHQ-9 ⩾ 10). Analyses were adjusted for total waking time per day, age, sex, education level, type 2 diabetes mellitus, body mass index, total energy intake, smoking status and alcohol use.

RESULTS

During 7812.81 person-years of follow-up, 203 (9.8%) participants developed incident depressive symptoms. No significant associations [Hazard Ratio (95% confidence interval)] were found between sex-specific tertiles of ST (lowest v. highest tertile) [1.13 (0.76-1.66], or HPA (highest v. lowest tertile) [1.14 (0.78-1.69)] and incident depressive symptoms. LPA (highest v. lowest tertile) was statistically significantly associated with incident depressive symptoms in women [1.98 (1.19-3.29)], but not in men (p-interaction <0.01).

CONCLUSIONS

We did not observe an association between ST or HPA and incident depressive symptoms. Lower levels of daily LPA were associated with an increased risk of incident depressive symptoms in women. Future research is needed to investigate accelerometer-derived measured physical activity and ST with incident depressive symptoms, preferably stratified by sex.

Perceived barriers and enablers to physical activity participation in people with Alopecia Areata: a constructivist grounded theory study

BACKGROUND

Alopecia Areata (AA) is an autoimmune disease that is characterised by hair loss. Individuals diagnosed with it often describe feelings of trauma and social rejection due to cosmetic repercussions and are at high risk of experiencing psychological distress. Physical activity (PA) participation has been associated with better mental health outcomes in diverse populations. A preliminary study of individuals with AA indicated that severe hair loss is associated with symptomatic depression, anxiety and stress, which negatively impacted PA participation. While strategies to increase PA participation in the general population have been established, little is known about PA participation in people with AA. This study aimed to understand barriers and enablers to PA participation in people with AA to inform the development of evidence-based interventions.

METHODS

The study used a grounded theory (GT) methodology, relying on an iterative and simultaneous process of data collection, coding, theory development, and data comparisons to explore the perceived barriers and enablers to PA. Data were collected through a focus group (8 participants [33.38 ± 10.81 years]) and individual telephone interviews (8 participants [33.89 ± 11.87 years]). The study was conducted in Melbourne, Australia. Interview data were recorded digitally, transcribed verbatim and analysed. Recruitment continued until theoretical saturation was achieved.

RESULTS

The constructivist grounded theory method used has assisted to develop an explanatory model which is used to explain the themes for barriers and enablers to PA participation. The four phases in the explanatory model are as follows (1) onset of AA; (2) reaction towards the condition; (3) adjustment; and (4) acceptance.

CONCLUSION

The findings highlighted perceived barriers and enablers to PA participation in people with AA. Future interventions could consider addressing these barriers specifically to maximise effectiveness and to improve mental health status based on the phases of the explanatory model.

The psychology of obesity: An umbrella review and evidence-based map of the psychological correlates of heavier body weight

Psychological factors may explain why some people develop obesity and others remain a normal weight during their life course. We use an umbrella review approach to build an evidence-based map of the psychological correlates of heavier body weight. Synthesising findings from 42 meta-analyses that have examined associations between psychological factors and heavier body weight, we assessed level of evidence for a range of cognitive, psychosocial and mental health individual difference factors. There is convincing evidence that impaired mental health is associated with heavier body weight and highly suggestive evidence that numerous cognitive factors are associated with heavier body weight. However, the relatively low methodological quality of meta-analyses resulted in lower evidential certainty for most psychosocial factors. Psychological correlates of heavier body weight tended to be small in statistical size and on average, people with obesity were likely to be more psychologically similar than different to people with normal weight. We consider implications for understanding the development of heavier body weight and identifying effective public health interventions to reduce obesity.

Pilot Studies to Evaluate Feasibility of a Physical Activity Intervention for Persons With Depression

Exercise reduces depressive symptoms and improves physical health in persons with depression. However, the interventions implemented in research studies require significant resources, limiting adoption into clinical practice and suggesting the need for more efficient interventions. In two nonrandomized pilot studies, the authors evaluated the feasibility of a multicomponent intervention (group educational sessions, Fitbit, and access to exercise facility) in adult persons with depression and breast cancer survivors with depression. The participants in both pilot studies completed 12 weeks of group educational sessions to increase physical activity levels, were provided with self-monitoring devices, and were provided access to on-site exercise facilities. Depressive symptoms significantly decreased postintervention, and over 90% of the participants reported that they had benefited from the intervention. These results indicate that implementing a multicomponent intervention is feasible and may reduce depressive symptoms and improve other psychosocial outcomes.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

A cross-sectional analysis of physical activity and weight misreporting in diverse populations: The Seattle Obesity Study III

BACKGROUND

In-person assessments of physical activity (PA) and body weight can be burdensome for participants and cost prohibitive for researchers. This study examined self-reported PA and weight accuracy and identified patterns of misreporting in a diverse sample.

METHODS

King, Pierce and Yakima county residents, aged 21-59 years (n = 728), self-reported their moderate-to-vigorous PA (MVPA) and weight, in kilograms. Self-reports were compared with minutes of bout-level MVPA, from 3 days of accelerometer data, and measured weights. Regression models examined characteristics associated with underreporting and overreporting of MVPA and weight, the potential bias introduced using each measure and the relation between perceived and measured PA and weight.

RESULTS

MVPA underreporting was higher among males and college educated participants; however, there was no differential MVPA overreporting. Weight underreporting was higher among males, those age 40-49 years and persons with obesity. Weight overreporting was higher among Hispanic participants and those reporting stress, unhappiness and fair or poor health. The estimated PA-obesity relation was similar using measured and self-reported PA but not self-reported weight. Perceived PA and weight predicted measured values.

CONCLUSION

Self-reported PA and weight may be useful should objective measurement be infeasible; however, though population-specific adjustment for differential reporting should be considered.

Adjuvant Guided Exercise Therapy Versus Self-Organized Activity in Patients With Major Depression

Exercise seems to be effective in reducing depression itself, as well as the risk of relapse. This study evaluated whether standardized guided exercise therapy (GET) in comparison with self-organized activity (SOA) is an effective augmentation therapy in depressive adults. A total of 111 inpatients (66.7% women; mean age, 45.05 ± 12.19 years) with major depression were randomly assigned to either GET or SOA. Interventions were performed three times a week, with each session lasting 50 minutes. Both GET and SOA exerted effects even after a short-term application of 6 weeks. GET was superior to SOA in reducing depression symptom severity, as measured by the Hamilton Depression Scale (p = 0.017), specifically improving suicidality (p = 0.028) as well as time (p = 0.003) and severity of diurnal variation (p = 0.027). The findings support the beneficial role of adjuvant GET in patients with major depression as a feasible treatment in a psychiatric short-term inpatient setting.

[Media coverage of prevention and treatment options using the examples of diabetes mellitus and depression]

BACKGROUND

Diabetes mellitus and depression are diseases with a rising prevalence in Germany. Journalistic media coverage offers the opportunity to inform the public about options for prevention and therapy. Research shows that media portrayals of different prevention and treatment options might influence health behavior as well as policy support and eventually structural healthcare.

OBJECTIVES

To date, little is known about the media coverage of the prevention and treatment of diabetes mellitus and depression. This study aims at demonstrating how diabetes mellitus and depression are portrayed in the German news media, focusing on options for prevention and therapy.

MATERIALS AND METHODS

A quantitative content analysis of German print and online media from 2012 to 2018 was conducted. In sum, N = 645 articles on diabetes mellitus (n = 219) and depression (n = 426) were analyzed.

RESULTS AND DISCUSSION

Diabetes mellitus and depression are rarely the main subject in German news coverage despite their high prevalence. Depression is reported more frequently than diabetes mellitus - often, however, in the context of suicide or celebrities. Regarding diabetes mellitus, reports differentiated insufficiently between the various types. For both conditions, pharmacotherapy was mentioned more frequently than low-threshold measures and structural prevention opportunities, which might have adverse consequences for those seeking help. Overall, to establish prevention and low-threshold forms of therapy as treatment options in the public, strategic communicators should focus more on them.

Review of Measuring Microenvironmental Changes at the Body-Seat Interface and the Relationship between Object Measurement and Subjective Evaluation

Being seated has increasingly pervaded both working and leisure lifestyles, with development of more comfortable seating surfaces dependent on feedback from subjective questionnaires and design aesthetics. As a consequence, research has become focused on how to objectively resolve factors that might underpin comfort and discomfort. This review summarizes objective methods of measuring the microenvironmental changes at the body–seat interface and examines the relationship between objective measurement and subjective sensation. From the perspective of physical parameters, pressure detection accounted for nearly two thirds (37/54) of the publications, followed by microclimatic information (temperature and relative humidity: 18/54): it is to be noted that one article included both microclimate and pressure measurements and was placed into both categories. In fact, accumulated temperature and relative humidity at the body–seat interface have similarly negative effects on prolonged sitting to that of unrelieved pressure. Another interesting finding was the correlation between objective measurement and subjective evaluation; however, the validity of this may be called into question because of the differences in experiment design between studies.

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

Background

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

Methods

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

Results

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

Conclusion

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

Correlates of metabolic syndrome in patients with depression: A study from north-western India

BACKGROUND AND AIMS

Metabolic syndrome (MS) is found to be prevalent in patients with mental illness including depression. Data is sparse on the role of lifestyle factors on MS in depression.

METHODS

This study was aimed to assess correlates of MS in patients with depression.

METHODOLOGY

Three hundred eighty-two patients with depressive disorders were assessed for the prevalence of MS by using modified National Cholesterol Education Program- Adult Treatment Panel-III criteria (NCEP ATP-III). Their illness severity, functionality, physical activity and nutritional habits were also assessed.

CONCLUSIONS

Majority of patients with depression (82.2%) were drug naive. One-fourth of the patients had metabolic syndrome (27.7%). Additionally, other 59% of patients had one or two metabolic abnormalities and one-third of patients were obese. Lower high density lipoprotein cholesterol level was the most common abnormality (65%), while abnormal blood pressure was the least common abnormality (18%). Significant correlates of MS were greater age, and age at onset of depression, greater illness duration, lesser physical activity and lower nutritional score.

CONCLUSION

Nearly one-fourth of patients with depression had MS; another three-fifth of patients had one or two metabolic abnormalities. MS was more commonly seen with sedentary lifestyle and poor nutritional habits. It calls for comprehensive assessment and timely management of cardiovascular risk factors as well as lifestyle factors in depression.

Youth diet quality and hazard of mood disorder in adolescence and adulthood among an Australian cohort

BACKGROUND

Prospective studies on youth diet and mood disorders outcomes are limited. We examined if youth diet quality was associated with mood disorder onset over a 25-year follow-up period.

METHODS

In 1985, Australian participants (aged 10-15 years) completed a 24-hour food record. A validated 100-point Dietary Guidelines Index (DGI) assessed diet quality. In 2009-11, 1005 participants (aged 33-41 years) completed the lifetime Composite International Diagnostic Interview for age of first DSM-IV defined mood disorder (depression or dysthymia). Cox proportional hazards regression estimated hazard of mood disorder during the 25-year follow-up according to baseline DGI score. Sensitivity analyses censored the study at 5, 10, and 15 years after baseline and used log binomial regression to estimate relative risk (RR). Covariates included baseline negative affect, BMI, academic performance, smoking, breakfast eating, physical activity, and socioeconomic status.

RESULTS

The mean(SD) youth DGI score was 45.0(11.5). A 10-point higher DGI was not associated with hazard of mood disorder onset over the 25-year follow-up (Hazard Ratio (HR):1.00; 95% Confidence Interval (CI):0.89-1.13). The only indication that higher DGI might be associated with lower risk of mood disorder was within the first 5 years after baseline and this was not statistically significant (RR=0.85; 95% CI:0.60-1.18).

LIMITATIONS

Loss-to-follow-up. A single 24-hour food record may not represent usual diet.

CONCLUSION

Youth diet did not predict mood disorders in adulthood. The suggestions of a lower risk of mood disorder during late adolescence highlights that further prospective studies are needed.

Role of childhood maltreatment on weight and weight-related behaviors in adulthood

OBJECTIVE

This study investigated associations between child maltreatment and body mass, body weight perceptions, and weight control behaviors among men and women.

METHOD

Data were derived from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Multinomial logistic regression was used to investigate links between dimensions of childhood maltreatment and adult (a) classifications of body mass index (BMI), (b) discrepancies in perceived weight and actual BMI categories, and (c) normative and risky weight control behaviors.

RESULTS

Childhood maltreatment was highly predictive of BMI classification, weight perception discrepancies, and weight control behaviors for women. Women who reported physical abuse, sexual abuse, and neglect had increased risks for being slightly or very overweight, and among those who reported physical abuse and/or a combination of physical abuse and neglect, there is an increased likelihood of holding overweight perceptions. Finally, female victims of physical abuse, physical abuse and neglect, and of neglect only were more likely to adopt risky (e.g., diet pills or purging) versus normative (e.g., diet and exercise) weight control behaviors.

CONCLUSION

Results indicated that women who reported childhood maltreatment have increased risks for developing body and weight related issues, confirming research documenting female-specific effects of childhood maltreatment. For women, certain forms of maltreatment strongly predicted BMI groupings, discrepant weight perceptions, and risky weight behaviors. Taken together, findings suggest that child maltreatment is a predictor of health-related outcomes. Moreover, results highlight the importance of assessing gender-specific effects when examining outcomes related to body, weight, and dieting. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Aerobic exercise or stretching as add-on to inpatient treatment of depression: Similar antidepressant effects on depressive symptoms and larger effects on working memory for aerobic exercise alone

BACKGROUND

Aerobic exercise (AE) has positive effects on symptom severity and cognitive symptoms of depression. Since data on AE as add-on to inpatient treatment in depression is still scarce, we conducted this double-blind randomized controlled study.

METHODS

Patients aged between 18 and 60 years were recruited into the study if Hamilton Depression Rating Scale 17 (HDRS-17) score was >16. Participants were randomly assigned to either AE or basic stretching activities (control), which took place 3x/week for 6 weeks. Primary outcome was depression severity as assessed with the HDRS-17 and the Beck Depression Inventory (BDI). Further physiological and psychological variables and cognitive performance were assessed as secondary outcomes.

RESULTS

Forty-two patients were included in the analysis (exercise: n = 22; control: n = 20). Regardless of group allocation, we found a significant short-term time effect for symptom-severity (HDRS17: p<0.001, η²=0.70; BDI: p<0.001, η²=0.51), mental toughness (p<0.001, η²=0.32), physical self-description endurance score (p = 0.013, η²=0.16), cognitive flexibility (p = 0.013, η²=0.14), and body mass index (BMI) (p = 0.006, η²=0.19). Working memory showed a significant time by group interaction in favor of AE (p = 0.043, η²=0.10). Short-term effects on symptom severity, mental toughness and BMI remained stable across the 6-month follow-up period. Finally, self-reported physical activity increased significantly from baseline to follow-up (p = 0.014, η²=0.15).

LIMITATIONS

The sample-size is rather small. The control intervention might have been too active as to find a time by group interaction for symptom severity.

CONCLUSIONS

AE was associated with comparably large depression alleviation vs. stretching and with add-on benefits on working memory.

Impact of flooding on health-related quality of life in England: results from the National Study of Flooding and Health

BACKGROUND

Flooding can have extensive effects on the health and wellbeing of affected communities. The impact of flooding on psychological morbidity has been established; however, the wider impacts of flooding exposure, including on health-related quality of life (HRQoL), have not been described.

METHODS

Using data from the English National Study of Flooding and Health cohort, HRQoL 2 and 3 years post-flooding was assessed with the EuroQol Group EQ-5D-5L tool. Associations between exposure groups (flooding and disruption from flooding) and HRQoL were assessed, using ordinal and linear regression, adjusting for a priori confounders.

RESULTS

For both 2 and 3 years post-flooding, the median HRQoL scores were lower in the flooded and disrupted groups, compared with unaffected respondents. A higher proportion of flooded and disrupted respondents reported HRQoL problems in most dimensions of the EQ-5D-5L, compared with unaffected respondents. In year 2, independent associations between exposure to flooding and experiencing anxiety/depression [adjusted odds ratio (aOR) 7.7; 95% CI 4.6-13.5], problems with usual activities (aOR 5.3; 95% CI 2.5-11.9) and pain/discomfort (aOR 2.4; 95% CI 1.5-3.9) were identified. These problems persisted 3 years post-flooding; associations between exposure to flooding and experiencing anxiety/depression (aOR 4.3; 95% CI 2.5-7.7), problems with usual activities (aOR 2.9; 95% CI 1.5-6.1) and pain/discomfort (aOR 2.5; 95% CI 1.5-4.2) were identified.

CONCLUSIONS

Exposure to flooding and disruption from flooding significantly reduces HRQoL. These findings extend our knowledge of the impacts of flooding on health, with implications for multi-agency emergency response and recovery plans.

Depressed mood and anxiety as risk factors for hypertensive disorders of pregnancy: a systematic review and meta-analysis

BACKGROUND

Psychosocial factors have been implicated as both a cause and consequence of hypertension in the general population but are less understood in relation to hypertensive disorders of pregnancy (HDP). The aims of this review were to (1) synthesize the existing literature examining associations between depression and/or anxiety in pregnancy and HDP and (2) assess if depression and/or anxiety in early pregnancy was a risk factor for HDP.

METHODS

A comprehensive search of Medline, Embase, CINAHL, and PsycINFO was conducted from inception to March 2020 using terms related to 'pregnancy', 'anxiety', 'depression', and 'hypertensive disorders'. English-language cohort and case-control studies were included if they reported: (a) the presence or absence of clinically significant symptoms of depression/anxiety, or a medical record diagnosis of depression or an anxiety disorder in pregnancy; (b) diagnosis of HDP; and/or (c) data comparing the depressed/anxious group to the non-depressed/anxious group on HDP. Data related to depression/anxiety, HDP, study characteristics, and aspects related to study quality were extracted independently by two reviewers. Random-effects meta-analyses of estimated pooled relative risks (RRs) were conducted for depression/anxiety in pregnancy and HDP.

RESULTS

In total, 6291 citations were retrieved, and 44 studies were included across 61.2 million pregnancies. Depression and/or anxiety were associated with HDP [RR = 1.39; 95% confidence interval (CI) 1.25-1.54].

CONCLUSIONS

When measurement of anxiety or depression preceded diagnosis of hypertension, the association remained (RR = 1.27; 95% CI 1.07-1.50). Women experiencing depression or anxiety in pregnancy have an increased prevalence of HDP compared to their non-depressed or non-anxious counterparts.

The Effects of Exclusively Resistance Training-Based Supervised Programs in People with Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The purpose of this study was to systematically review the effects of supervised resistance training (RT) programs in people diagnosed with depression or depressive symptoms. The following databases were used to search and retrieve the articles: Cochrane Library, EBSCO, PEDro, PubMed, Scopus and Web of Science. The search was conducted in late June 2020. Search protocol required the title to contain the words depression or depressive or dysthymia. Furthermore, the title, abstract or keywords had to contain the words or expressions: "randomized controlled trial"; and "strength training" or "resistance training" or "resisted training" or "weight training". The screening provided 136 results. After the removal of duplicates, 70 records remained. Further screening of titles and abstracts resulted in the elimination of 57 papers. Therefore, 13 records were eligible for further scrutiny. Of the 13 records, nine were excluded, and the final sample consisted of four articles. Results were highly heterogeneous, with half of the studies showing positive effects of resistance training and half showing no effects. In two of the four combinations, the meta-analysis revealed significant benefits of RT in improving depressive symptoms (p ≤ 0.05). However, considering significant differences with moderate (Effect Size = 0.62) and small (ES = 0.53) effects, the heterogeneity was above 50%, thus suggesting a substantial level. To draw meaningful conclusions, future well-designed randomized controlled trials (RCTs) are needed that focus on understudied RT as a treatment for depression.

Vitamin D Doses from Solar Ultraviolet and Dietary Intakes in Patients with Depression: Results of a Case-Control Study

The purpose of this study to estimate cumulative vitamin D doses from solar ultraviolet and dietary intakes in patients with depression and compare it to healthy controls. Using a case-control research design, a sample of 96 patients with depression were age- and sex-matched with 96 healthy controls. Dietary vitamin D dose was estimated from diet analysis. Vitamin D-weighted ultraviolet solar doses were estimated from action spectrum conversion factors and geometric conversion factors accounting for the skin type, the fraction of body exposed, and age factor. Patients with depression had a lower dose of vitamin D (IU) per day with 234, 153, and 81 per day from all sources, sunlight exposure, and dietary intake, respectively. Controls had a higher intake of vitamin D (IU) per day with 357, 270, and 87 per day from all sources, sunlight exposure, and dietary intake, respectively. Only 19% and 30% met the minimum daily recommended dose of ≥400 IU per day for cases and controls, respectively. The sensitivity, specificity, percentage correctly classified and receiver operating characteristic (ROC) Area for the estimated vitamin D against serum vitamin D as reference were 100%, 79%, 80%, and 89%. Physical activity level was the only predictor of daily vitamin D dose. Vitamin D doses are lower than the recommended dose of ≥400 IU (10 mcg) per day for both cases with depression and healthy controls, being much lower in the former.

Quality of life in heart failure patients undergoing hybrid comprehensive telerehabilitation versus usual care - results of the Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomized Clinical Trial

INTRODUCTION

Hybrid comprehensive telerehabilitation (HCTR) consisting of telecare (with psychological telesupport), telerehabilitation and remote monitoring of implantable devices might be an innovative option improving heart failure (HF) patients' quality of life (QoL) and emotional health. The aim of the study was to investigate the influence of HCTR on various facets of QoL in HF patients in comparison with usual care (UC) alone.

MATERIAL AND METHODS

The present analysis formed part of a multicenter, randomized trial that enrolled 850 HF patients (NYHA I-III, LVEF ≤ 40%). Patients were randomized 1 : 1 to HCTR plus UC or UC only. Patients underwent either an HCTR program or UC with observation. The psychological intervention in the HCTR group included supportive psychological counseling via mobile phone. The Medical Outcome Survey Short Form 36 Questionnaire was used to assess QoL. Measurements were made before and after a 9-week intervention (HCTR group)/observation (UC group).

RESULTS

After the intervention, the HCTR group showed significant improvement in overall QoL, physical domain (PD) of QoL, and 4 areas of QoL (physical functioning (PhF), role functioning related to physical state (RF), general health (GH), vitality (VI)). A significant positive change in QoL in the UC group was observed only in VI and social functioning. There were also significant differences in QoL after 9-week intervention/observation between the two groups. The results showed greater improvement in HCTR for overall QoL (p = 0.009), PD of QoL (p = 0.0003) and three specific areas of QoL: PhF (p = 0.001), RF (p = 0.003), bodily pain (BP) (p = 0.015).

CONCLUSIONS

In comparison to UC, HCTR resulted in improvement in overall QoL, PD of QoL and 3 specific areas of QoL: PhF, RF and BP.

Trajectories and associations between depression and physical activity in patients with cardiovascular disease during participation in an internet-based cognitive behavioural therapy programme

BACKGROUND

There is a lack of knowledge about internet-based cognitive behavioural therapy in patients with cardiovascular disease, and its effects on depressive symptoms and physical activity.

AIM

To examine trajectories of depressive symptoms and physical activity, and to explore if these trajectories are linked with the delivery of internet-based cognitive behavioural therapy.

METHODS

A secondary-analysis of data collected in a randomised controlled trial that evaluated the effects of a 9-week internet-based cognitive behavioural therapy programme compared to an online discussion forum on depressive symptoms in cardiovascular disease patients. Data were collected at baseline, once weekly during the 9-week intervention period and at the 9-week follow-up. The Montgomery Åsberg depression rating scale - self-rating (MADRS-S) was used to measure depressive symptoms. Two modified items from the physical activity questionnaire measuring frequency and length of physical activity were merged to form a physical activity factor.

RESULTS

After 2 weeks the internet-based cognitive behavioural therapy group had a temporary worsening in depressive symptoms. At 9-week follow-up, depressive symptoms (P<0.001) and physical activity (P=0.02) had improved more in the internet-based cognitive behavioural therapy group. Only in the internet-based cognitive behavioural therapy group, was a significant correlation (r=-0.39, P=0.002) between changes in depressive symptoms and changes in physical activity found. Structural equation analyses revealed that internet-based cognitive behavioural therapy decreased depressive symptoms, and that a decrease in depression, in turn, resulted in an increase in physical activity.

CONCLUSIONS

Internet-based cognitive behavioural therapy was more effective than an online discussion forum to decrease depressive symptoms and increase physical activity. Importantly, a decrease in depressive symptoms needs to precede an increase in physical activity.

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

BACKGROUND

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

AIMS

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Physical Activity Promotes Health and Reduces Cardiovascular Mortality in Depressed Populations: A Literature Overview

Major depression is associated with premature mortality, largely explained by heightened cardiovascular burden. This narrative review summarizes secondary literature (i.e., reviews and meta-analyses) on this topic, considering physical exercise as a potential tool to counteract this alarming phenomenon. Compared to healthy controls, individuals with depression consistently present heightened cardiovascular risk, including "classical" risk factors and dysregulation of pertinent homeostatic systems (immune system, hypothalamic-pituitary-adrenal axis and autonomic nervous system). Ultimately, both genetic background and behavioral abnormalities contribute to explain the link between depression and cardiovascular mortality. Physical inactivity is particularly common in depressed populations and may represent an elective therapeutic target to address premature mortality. Exercise-based interventions, in fact, have proven effective reducing cardiovascular risk and mortality through different mechanisms, although evidence still needs to be replicated in depressed populations. Notably, exercise also directly improves depressive symptoms. Despite its potential, however, exercise remains under-prescribed to depressed individuals. Public health may be the ideal setting to develop and disseminate initiatives that promote the prescription and delivery of exercise-based interventions, with a particular focus on their cost-effectiveness.

The Feasibility and Efficacy of a Brief Integrative Treatment for Adults With Depression and/or Anxiety: A Randomized Controlled Trial

The aim of this study was to investigate the efficacy and suitability of a brief integrative intervention, Personalized Integrative Therapy (PI Therapy), for the treatment of adult depression and/or anxiety. In this 6-week, 3-arm, parallel-group, randomized trial, PI Therapy delivered alone or with nutritional supplements (PI Therapy + Supps) was compared to cognitive behavior therapy (CBT) in 48 adults with depression and/or anxiety. All treatments were delivered as a 1-day workshop plus 6 weeks of reminder phone text messages to reinforce topics and skills covered in the workshop. Affective symptoms decreased significantly and to the same extent in all 3 conditions. At the end of treatment, 33% to 58% of participants reported levels of depressive symptoms in the normal range, and 50% to 58% reported nonclinical levels of anxiety. Compared to CBT and PI Therapy, PI Therapy + Supps was associated with significantly greater improvements in sleep quality. These findings suggest that a brief integrative intervention with or without supplements was comparable to CBT in reducing affective symptoms in adults with depression and/or anxiety. However, sleep quality improved only in the PI Therapy + Supps condition. These findings will require replication with a larger cohort.

Using the Minnesota Multiphasic Personality Inventory-2-Restructured Form Cutoffs to Predict Lack of Pre-surgical Exercise

Previous studies suggest the importance of understanding what factors increase risk of lack of physical activity (PA) prior to bariatric surgery, which may increase risk of suboptimal postoperative outcomes. Therefore, the current study sought to explore which Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scales were associated with lack of pre-surgical PA. The mean age of the sample (N = 1170) was 45.97 years [standard deviation (SD) = 11.59]. Bivariate correlations and relative risk ratios were utilized to examine associations between MMPI-2-RF scale scores and regular preoperative PA. Of the ten hypothesized associations, seven MMPI-2-RF scales in the internalizing and somatic domains were associated with increased risk of preoperative lack of PA. Interventions designed to increase levels of preoperative PA are especially important because individuals with higher levels of preoperative cardiorespiratory fitness experience less complications in surgery and greater weight loss postoperatively.

Does meeting physical activity recommendations ameliorate association between television viewing with cardiovascular disease risk? A cross-sectional, population-based analysis

OBJECTIVES

As a common form of sedentary behaviour, television viewing is associated with an increase in body mass index (BMI) as well as overall cardiovascular disease (CVD) risk. This study examined the extent to which meeting the recommended volume of weekly physical activity (PA) reduced the association between television viewing with the outcomes of BMI and CVD risk. A second aim was to determine the number of hours (ie, cut-point) of daily television viewing that conferred a higher BMI and CVD risk for a large population-based sample of adults.

DESIGN

Population-based, cross-sectional study.

SETTING

UK Biobank recruited across 35 centres in the UK between 2006 and 2010.

PRIMARY OUTCOME

CVD risk, as measured by the 30-year Framingham risk score.

RESULTS

Linear regression models indicated that every additional hour of television viewing per day was associated with a 3% increase in CVD risk (aCoeff=0.03, d=0.16, p<0.0001); the interaction between television viewing with meeting PA guidelines was marginally associated with CVD risk (aCoeff=0.0010, d=0.01, p=0.014). Each additional hour of television viewing per day was associated with a 0.54 increase in BMI (aCoeff=0.54, d=0.13, p<0.0001); the interaction between television viewing with meeting PA guidelines was not significantly associated with BMI. Regression tree models of the study outcomes revealed that 2.5 hours of television viewing was associated with pronounced increases in BMI and CVD risk.

CONCLUSIONS

These data underscore the independent association between television viewing with cardiovascular risk and suggest that reducing television viewing to less than 2.5 hours per day, even in physically active adults, is a clinical and public health priority.

Relationship of non-melancholic and melancholic depressive symptoms with all-cause mortality: A prospective study in a primary care population

OBJECTIVE

To assess relationship of non-melancholic and melancholic subtypes of depressive symptoms with all-cause mortality among cardiovascular risk persons.

METHODS

A population-based prospective study of 2522 Finnish middle-aged persons with elevated cardiovascular risk was conducted. Depressive symptoms were assessed by the Beck's Depression Inventory. Data on mortality were obtained from The Official Statistics of Finland after 11-year follow-up.

RESULTS

At baseline, the prevalence of non-melancholic and melancholic depressive symptoms was 14.9% and 5.2%, respectively. During the mean follow-up time of 11 years, 8.1% (n = 164) of those without, 13.9% (n = 52) of those with non-melancholic, and 10.7% (n = 14) of those with melancholic depressive symptoms died. Compared to non-depressive subjects, the hazard ratio for time to all-cause mortality was 1.67 (95% CI: 1.21-2.32, p = .002) in non-melancholically depressive and 1.01 (95% CI: 0.56-1.83, p = .97) in melancholically depressive subjects, when adjusted for age, gender, education, smoking, alcohol use, BMI, hypertension, dyslipidaemia, and glucose disorders. In comparison to the mortality rate in the general population throughout Finland over the same period, non-depressiveness was associated with a decreased standardized mortality rate.

CONCLUSION

Non-melancholic depressive symptoms seem to be associated with excess all-cause mortality. In clinical settings, recognition of non-melancholic depressive symptoms should be emphasised.

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

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

Depression and Objectively Measured Physical Activity: A Systematic Review and Meta-Analysis

Depression is a major contributor to the overall global burden of disease, with high prevalence and relapse rate. Several factors have been considered in order to reduce the depression burden. Among them, physical activity (PA) showed a potential protective role. However, evidence is contrasting probably because of the differences in PA measurement. The aim of this systematic review with meta-analysis is to assess the association between objectively measured PA and incident and prevalent depression. The systematic review was conducted according to methods recommended by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant papers published through 31 August 2019 were identified searching through the electronic databases PubMed/MEDLINE, Excerpta Medica dataBASE (Embase), PsycINFO, Scopus, Web of Science (WoS), and the Cochrane Library. All analyses were conducted using ProMeta3. Finally, 42 studies met inclusion criteria. The overall Effect size (ES) of depression for the highest vs. the lowest level of PA was −1.16 [(95% CI = −1.41; −0.91), p-value < 0.001] based on 37,408 participants. The results of the meta-analysis showed a potential protective effect of PA on prevalent and incident depression.

Effects of yoga on depressive symptoms in people with mental disorders: a systematic review and meta-analysis

OBJECTIVE

To assess whether physically active yoga is superior to waitlist control, treatment as usual and attention control in alleviating depressive symptoms in people with a diagnosed mental disorder recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM).

DESIGN

Systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

Data were obtained from online databases (MEDLINE, EMBASE, PsychINFO, CENTRAL, EMCARE, PEDro). The search and collection of eligible studies was conducted up to 14 May 2019 (PROSPERO registration No CRD42018090441).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included randomised controlled trials with a yoga intervention comprising ≥50% physical activity in adults with a recognised diagnosed mental disorder according to DSM-3, 4 or 5.

RESULTS

19 studies were included in the review (1080 participants) and 13 studies were included in the meta-analysis (632 participants). Disorders of depression, post-traumatic stress, schizophrenia, anxiety, alcohol dependence and bipolar were included. Yoga showed greater reductions in depressive symptoms than waitlist, treatment as usual and attention control (standardised mean difference=0.41; 95% CI -0.65 to -0.17; p<0.001). Greater reductions in depressive symptoms were associated with higher frequency of yoga sessions per week (β=-0.44, p<0.01).

Life within a limited radius: Investigating activity space in women with a history of child abuse using global positioning system tracking

Early experiences of childhood sexual or physical abuse are often associated with functional impairments, reduced well-being and interpersonal problems in adulthood. Prior studies have addressed whether the traumatic experience itself or adult psychopathology is linked to these limitations. To approach this question, individuals with posttraumatic stress disorder (PTSD) and healthy individuals with and without a history of child abuse were investigated. We used global positioning system (GPS) tracking to study temporal and spatial limitations in the participants’ real-life activity space over the course of one week. The sample consisted of 228 female participants: 150 women with PTSD and emotional instability with a history of child abuse, 35 mentally healthy women with a history of child abuse (healthy trauma controls, HTC) and 43 mentally healthy women without any traumatic experiences in their past (healthy controls, HC). Both traumatized groups—i.e. the PTSD and the HTC group—had smaller movement radii than the HC group on the weekends, but neither spent significantly less time away from home than HC. Some differences between PTSD and HC in movement radius seem to be related to correlates of PTSD psychopathology, like depression and physical health. Yet group differences between HTC and HC in movement radius remained even when contextual and individual health variables were included in the model, indicating specific effects of traumatic experiences on activity space. Experiences of child abuse could limit activity space later in life, regardless of whether PTSD develops.

Effects of Aerobic Exercise on Cortisol Stress Reactivity in Response to the Trier Social Stress Test in Inpatients with Major Depressive Disorders: A Randomized Controlled Trial

Physical activity is associated with a favourable (blunted) cortisol stress reactivity in healthy people. However, evidence from experimental study and with psychiatric patients is missing. This study examines whether exercise training impacts on cortisol stress reactivity in inpatients with major depressive disorder (MDD). These new insights are important because the stress reactivity of healthy people and patients with severe symptoms of depression might differ. Methods: The study was designed as a randomized controlled trial (trial registration number: NCT02679053). In total, 25 patients (13 women, 12 men, mean age: 38.1 12.0 years) completed a laboratory stressor task before and after a six-week intervention period. Nine samples of salivary free cortisol were taken before and after the Trier social stress test (TSST). Fourteen participants took part in six weeks of aerobic exercise training, while 11 patients were allocated to the control condition. While the primary outcome of the study was depressive symptom severity, the focus of this paper is on one of the secondary outcomes (cortisol reactivity during the TSST). The impact of aerobic exercise training was examined with a repeated-measures analysis of variance. We also examined the association between change in depression and cortisol response via correlational analysis. Cortisol reactivity did not change from baseline to post-intervention, either in the intervention or the control group. Participation in six weeks of aerobic exercise training was not associated with participants' cortisol reactivity. Moreover, depressive symptom change was not associated with change in cortisol response. Aerobic exercise training was not associated with patients' stress reactivity in this study. Because many patients initially showed a relatively flat/blunted cortisol response curve, efforts might be needed to find out which treatments are most efficient to promote a normalization of HPA axis reactivity.

Exercise interventions for mental disorders in young people: a scoping review

AIMS

This scoping review determines the breadth and outcomes of controlled trials testing the effect of physical activity/exercise interventions across mental health outcomes in young people with a mental disorder.

METHODS

The literature search was conducted using the open-access 'Evidence Finder', a comprehensive youth mental health-specific database that is systematically populated from MEDLINE, Embase, PsycINFO and Cochrane CENTRAL databases.

RESULTS

Sixteen publications were identified after meeting the following eligibility criteria: (1) participants were young people (mean age 12-25.9 years) with a mental disorder diagnosed by a trained clinician or by reaching a predefined cut score on a symptom measure, (2) interventions were exercise, (3) designs were randomised or non-randomised controlled trials, (4) outcomes were mental health related. Eight studies included young people with depression, three included people with psychosis/schizophrenia, three included people with eating disorders and two included people with anxiety. The available evidence suggests that moderate-to-vigorous-intensity exercise may be beneficial, particularly for reducing depression. The available evidence for other intervention intensities, and for other mental disorders, is mixed.

CONCLUSIONS

Overall, the evidence regarding the impact of exercise interventions on a range of mental health outcomes in clinical populations of young people with various mental disorders looks promising but requires further development. Findings from this scoping review can inform the development of future exercise interventions in the youth mental health field.

Independent relationships between different domains of physical activity and depressive symptoms among 60,202 Brazilian adults

OBJECTIVE

To analyze the association between four key different physical activity (PA) domains and depressive symptoms among Brazilian adults.

METHODS

Data from the Brazilian National Health Survey (n = 60,202; ≥18 years) were used. PA across four different domains (leisure, transport, occupational and household) was collected through specific questionnaires. The cutoff point adopted in each domain was 150 min/week. Depression was evaluated through the Patient Health Questionnaire-9. Multivariable adjusted linear and logistic regression models were applied.

RESULTS

Leisure PA was associated with lower depressive symptoms [β: -0.008 (95% CI: -0.010 to -0.005); OR: 0.69 (95% CI: 0.59 to 0.81)]. Transport PA was also associated with lower depressive symptoms among older adults [β -0.008 (-0.012 to -0.003); OR: 0.70 (95% CI: 0.53-0.94)] but not middle-aged adults. On the other hand, occupational PA [β: 0.003 (95% CI: 0.002 to 0.005); OR: 1.62 (95% CI: 1.38 to 1.91)] and household PA [β: 0.009 (95% CI: 0.006 to 0.012); OR: 1.57 (95% CI: 1.37 to 1.79)] were associated with higher depressive symptoms.

CONCLUSION

The association between PA and depression symptoms varies according to the domains of PA and some appear independent from each other. While leisure PA is associated with fewer depressive symptoms; occupational and household PA appear to be associated with an increased depression risk.

Berendschot T, S.A.G. Schouten J, Kroon AA, van der Kallen CJ, Henry RM, van Dongen MC, J.P.M. Eussen S, H.C.M. Savelberg H, van der Berg JD, Schaper NC, Schram MT, Stehouwer CD. Higher levels of daily physical activity are associated with better skin microvascular function in type 2 diabetes-The Maastricht Study

OBJECTIVE

Physical activity may provide a means for the prevention of cardiovascular disease via improving microvascular function. Therefore, this study investigated whether physical activity is associated with skin and retinal microvascular function.

METHODS

In The Maastricht Study, a population-based cohort study enriched with type 2 diabetes (n = 1298, 47.3% women, aged 60.2 ± 8.1 years, 29.5% type 2 diabetes), we studied whether accelerometer-assessed physical activity and sedentary time associate with skin and retinal microvascular function. Associations were studied by linear regression and adjusted for major cardiovascular risk factors. In addition, we investigated whether associations were stronger in type 2 diabetes.

RESULTS

In individuals with type 2 diabetes, total physical activity and higher-intensity physical activity were independently associated with greater heat-induced skin hyperemia (regression coefficients per hour), respectively, 10 (95% CI: 1; 18) and 36 perfusion units (14; 58). In individuals without type 2 diabetes, total physical activity and higher-intensity physical activity were not associated with heat-induced skin hyperemia. No associations with retinal arteriolar %-dilation were identified.

CONCLUSION

Higher levels of total and higher-intensity physical activity were associated with greater skin microvascular vasodilation in individuals with, but not in those without, type 2 diabetes.

Ärztliche Vorbildfunktion bezüglich körperlicher Aktivität für Patienten mit psychischen Erkrankungen

Hintergrund

Körperliche Aktivität spielt eine bedeutende Rolle bei der Behandlung psychischer Störungen. Psychiatern/ärztlichen Psychotherapeuten kommt eine Schlüsselrolle dabei zu, ihren Patienten körperliche Aktivität zu empfehlen. Zum Empfehlungsverhalten dieses Kollektivs liegen bisher keine Untersuchungen vor.

Ziele der Arbeit

Das Empfehlungsverhalten in Bezug auf körperliche Aktivität sowie verhaltensbezogene und motivationale Korrelate, die das Empfehlungsverhalten potenziell beeinflussen, bei deutschen Psychiatern/ärztlichen Psychotherapeuten sollte untersucht werden.

Material und Methoden

Insgesamt beantworteten 151 deutsche Psychiater/ärztliche Psychotherapeuten (Alter: M = 32,5 Jahre; Geschlecht: 47,0 % weiblich) einen Onlinefragebogen bezüglich körperlicher Aktivität. Dabei wurden das Empfehlungsverhalten körperlicher Aktivität, die Einstellung, das eigene Aktivitätsverhalten und die Selbstkonkordanz eigener Motivation, körperlich aktiv zu sein, erfasst.

Ergebnisse

Die meisten Psychiater/ärztliche Psychotherapeuten gaben an, körperliche Aktivität einigen (54,5 %, n = 82) oder all ihren Patienten zu empfehlen (33,8 %, n = 51). Das Empfehlungsverhalten korrelierte signifikant positiv mit der Selbstkonkordanz der Motivation (r = 0,19) sowie mit der Einstellung zur Bedeutsamkeit körperlicher Aktivität (r = 0,16). Hingegen bestand keine signifikante Korrelation zwischen dem eignen Aktivitätsniveau und dem Empfehlungsverhalten der Psychiater/ärztlichen Psychotherapeuten (r = 0,04).

Schlussfolgerung

Ein Großteil der Psychiater/ärztlichen Psychotherapeuten empfiehlt körperliche Aktivität. Positiv auf das Empfehlungsverhalten wirkten sich insbesondere die Einschätzung der körperlichen Aktivität als bedeutsam sowie eine hohe Selbstkonkordanz der eigenen Motivation, körperlich aktiv zu sein, aus. Interventionsprogramme, die das Empfehlungsverhalten von Psychiatern/ärztlichen Psychotherapeuten steigern wollen, sollten auf die Selbstkonkordanz der Motivation der Psychiater/ärztlichen Psychotherapeuten, körperlich aktiv zu sein, fokussieren und sich nicht nur auf die Bedeutsamkeit körperlicher Aktivität konzentrieren.

Aquatic exercising may improve sexual function in females with multiple sclerosis - an exploratory study

BACKGROUND

Persons with multiple sclerosis (PwMS) report impaired sexual function, and this is particularly prevalent and burdensome for females with MS. The present study included a randomized controlled trial (RCT) design and examined the effect of aquatic exercise training on sexual function among females with MS.

METHODS

The sample consisted of 60 married female PwMS (mean age: 37.68 years; median EDSS: 1.75) who were randomly assigned into one of the following conditions: aquatic exercise twice a week (2x/w); aquatic exercise three times a week (3x/w); active control condition (ACC). Participants completed questionnaires regarding sexual function (desire, arousal, lubrication, orgasm, satisfaction, pain), symptoms of depression, sleep complaints, fatigue, and couple satisfaction before and after the 8-week study period.

RESULTS

The interventions had significant and positive effects on the overall score of sexual function (p < .001, η_ρ² = .35), all subscales (desire (p = .002, 2 = .20), arousal (p = .01, 2 =.15), lubrication (p = .011, 2 = .15), orgasm (p = .007, 2 = .16), satisfaction (p = .023, 2 = .13), pain (p = .02, 2 = .13)) and depression (p =.002, 2 = .20).The interventions had no significant and positive effects on fatigue (p = .31, 2 = .04) sleep complaints (p = .079, 2= .087), and couple satisfaction (p = .69, 2 = .01) compared with the active control condition.

CONCLUSIONS

Aquatic exercise training may improve sexual function among female PwMS, but this requires further examination using a large sample pre-screened for sexual dysfunction. If confirmed, the present findings are of clinical and practical importance for females with MS.

Relationship Between Pain and Sedentary Behavior in Rheumatoid Arthritis Patients: A Cross-Sectional Study

OBJECTIVE

Despite the known benefits of physical activity, high numbers of individuals with rheumatoid arthritis (RA) remain physically inactive and sedentary. Little is known about the determinants of sedentary behavior (SB) in RA. This cross-sectional study was undertaken to examine a range of pain characteristics and RA-related symptoms and their relationship with objectively measured SB.

METHODS

In total, 76 adults with RA wore an activPAL4 accelerometer (PAL Technologies) over a 7-day period. Pain characteristics (pain intensity, painful joint count, nonarticular pain), fatigue, sleep, depression, anxiety, and disease activity were assessed. Analyses were first conducted to evaluate correlations with sedentary time. The independent contribution of pain characteristics to variation in SB was analyzed with multivariable linear regression (adjusted for demographic data and disease activity).

RESULTS

Participants with valid accelerometer data (n = 72) spent a mean ± SD of 533.7 ± 100.1 minutes/day in SB. Positive associations with daily SB were found for pain intensity (r = 0.31, P < 0.01) and number of painful joints (r = 0.24, P < 0.05) but not nonarticular pain. In multivariable analyses, pain characteristics were not independently associated with SB. Analyses indicated that disease activity had an indirect association with SB mediated by pain intensity. Other correlates of daily SB included anxiety and depression but not fatigue or sleep.

CONCLUSION

Results suggest that while pain and other RA-related factors do play a role in SB, they do not appear to have a significant influence after accounting for other variables. Future research should investigate SB and the role of factors unrelated to the symptoms of RA.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

Influence of Regular Physical Activity on Mitochondrial Activity and Symptoms of Burnout-An Interventional Pilot Study

Background: Occupational burnout is both a serious public and individual health concern. Psychopharmacological and psychological interventions are often employed, while interventions involving physical activity have been less frequently studied. The aims of the present study were (1) to investigate the effects of physical activity on mitochondrial activity levels and symptoms of burnout, (2) to compare the mitochondrial activity levels and symptoms of burnout of individuals suffering burnout with those of healthy controls (HCs), and (3) to explore the associations between mitochondrial activity and burnout symptoms. Methods: Twelve males with burnout (mean age: M = 45.8 years) took part in the study. At baseline and after 12 weeks of an intervention involving physical activity, participants completed questionnaires covering symptoms of burnout and depression. In parallel, blood samples were taken to measure changes in mitochondrial functional outcomes, such as ATP levels, oxygen consumption and complex I. For comparison, baseline values of healthy controls (HCs; depression and burnout questionnaires; blood samples) were assessed. Results: Over time, symptoms of burnout (emotional exhaustion and depersonalization) and depression significantly decreased in participants with burnout (large effect sizes) but remained significantly higher than those of HCs (medium to large effect sizes). Personal accomplishment increased over time (medium effect size) but was still lower than for HCs (large effect size). At baseline and compared to HCs, individuals with burnout had significantly lower ATP levels of mitochondrial functional outcomes. Over time, mitochondrial activity levels increased among individuals with burnout. High baseline mitochondrial activity was significantly correlated with lower depression and burnout scores both at baseline and at the end of the study. Conclusions: In individuals with burnout, regular physical activity had positive effects on mitochondrial activity and on symptoms of burnout and depression. However, when compared to healthy controls, full remission was not achieved.

Exercise prescription for people with mental illness: an evaluation of mental health professionals' knowledge, beliefs, barriers, and behaviors

OBJECTIVE

The aim of this study was to understand the knowledge, beliefs, barriers, and behaviors of mental health professionals about physical activity and exercise for people with mental illness.

METHODS

The Portuguese version of The Exercise in Mental Illness Questionnaire was used to assess knowledge, beliefs, barriers, and behaviors about exercise prescription for people with mental illness in a sample of 73 mental health professionals (68.5% women, mean age = 37.0 years) from 10 Psychosocial Care Units (Centros de Atenção Psicossocial) in Porto Alegre and Canoas, state of Rio Grande do Sul, Brazil.

RESULTS

Most of respondents had received no formal training in exercise prescription. Exercise ranked fifth as the most important treatment, and most of the sample never or occasionally prescribed exercise. The most frequently reported barriers were lack of training in physical activity and exercise prescription and social stigma related to mental illness. Professionals who themselves met recommended physical activity levels found fewer barriers to prescribing physical activity and did so with greater frequency.

CONCLUSION

Exercise is underrated and underused as a treatment. It is necessary to include physical activity and exercise training in mental health curricula. Physically active professionals are more likely to prescribe exercise and are less likely to encounter barriers to doing so. Interventions to increase physical activity levels among mental health professionals are necessary to decrease barriers to and increase the prescription of physical activity and exercise for mental health patients.

Association of depression symptoms with receipt of healthcare provider advice on physical activity among US adults

BACKGROUND

Given the high burden and prevalence of depression, various guidelines underscore the role of healthcare providers in supplying advice on physical activity (PA) as a potential modifying factor influencing the incidence and severity of depressive symptoms in adults. We aimed to investigate the extent to which healthcare providers provide PA advice to adults with depressive symptoms in the US.

METHODS

Data on adults aged 20-64 years (n = 4971) in the National Health and Nutrition Examination Study between 2011 and 2016 were analysed. Depressive symptoms were assessed using the Patient Health Questionnaire and response options were categorised as "none or minimal", "mild", "moderate-severe". Receipt of PA advice from a healthcare provider was self-reported. We restricted our study sample to adults free from chronic diseases.

RESULTS

Higher odds of receiving advice to exercise were reported among adults with mild (OR = 1.7, 95% CI: 1.3-2.3) and moderate-severe depressive symptoms (OR = 1.7, 95% CI: 1.0-2.8). Furthermore, exercise advice was more commonly reported among adults who were overweight, obese, Hispanic, Asian, being insured with private insurance, with education higher than high school, and had access to a routine place for health care.

LIMITATIONS

Social and culutral aspects of overweight/obesity may prohibit generalizations. Cross sectional design does not allow for causal realtionships.

CONCLUSIONS

In the US, fewer than one in three adults experiencing symptoms of depression report having received exercise advice from a healthcare provider. Providing such advice may be a sustainable clinical strategy in reducing the incidence and severity of depression symptoms.

Instrumental assessment of balance and gait in depression: A systematic review

Psychomotor symptoms of depression are understudied despite having a severe impact on patient outcomes. This review aims to summarize the evidence on motor features of depression assessed with instrumental procedures, and examine age-related differences. We included studies investigating posture, balance and gait ascertained with instrumental measurements among individuals with depressive symptoms or disorders. Studies on subjects with specific physical illnesses were excluded. Methodological quality was assessed with the Newcastle - Ottawa Scale (NOS) and PRISMA guidelines were followed. 33 studies (13 case-control, five cross-sectional, nine longitudinal and six intervention) with overall low-medium quality were included. Different instruments were employed to assess posture (e.g. digital cameras), balance (balance, stepping platform) or gait (e.g. Six-Minute-Walking Test, instrumented walkways). Results suggest that depression in adults is associated with significant impairments of posture, balance and gait. Motor abnormalities among depressed older adults may depend on the interplay of physical diseases, cognitive impairment and mood. Very few intervention studies measured motor symptoms as outcome. Available evidence suggests, however, that antidepressant drugs and physical exercise may be beneficial for motor abnormalities. Despite the lack of high-quality studies, instrumental assessments confirm the presence and importance of motor abnormalities in depression, with potential age-related differences in their pathophysiology.

Sedentary behaviors and risk of depression: a meta-analysis of prospective studies

Epidemiological evidence on the association between sedentary behaviors and the risk of depression is inconsistent. We conducted a meta-analysis of prospective studies to identify the impact of sedentary behaviors on the risk of depression. We systematically searched in the PubMed and Embase databases to June 2019 for prospective cohort studies investigating sedentary behaviors in relation to the risk of depression. The pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated with random-effect meta-analysis. In addition, meta-regression analyses, subgroup analyses, and sensitivity analyses were performed to explore the potential sources of heterogeneity. Twelve prospective studies involving 128,553 participants were identified. A significantly positive association between sedentary behavior and the risk of depression was observed (RR = 1.10, 95% CI 1.03-1.19, I2 = 60.6%, P < 0.01). Subgroup analyses revealed that watching television was positively associated with the risk of depression (RR = 1.18, 95% CI 1.07-1.30), whereas using a computer was not (RR = 0.99, 95% CI 0.79-1.23). Mentally passive sedentary behaviors could increase the risk of depression (RR = 1.17, 95% CI 1.08-1.27), whereas the effect of mentally active sedentary behaviors were non-significant (RR = 0.98, 95% CI 0.83-1.15). Sedentary behaviors were positively related to depression defined by clinical diagnosis (RR = 1.08, 95% CI 1.03, 1.14), whereas the associations were statistically non-significant when depression was evaluated by the CES-D and the Prime-MD screening. The present study suggests that mentally passive sedentary behaviors, such as watching television, could increase the risk of depression. Interventions that reduce mentally passive sedentary behaviors may prevent depression.

Is Depression Associated with Unhealthy Behaviors among Middle-Aged and Older Women with Hypertension or Heart Disease?

OBJECTIVE

Depression is a common comorbidity in patients with cardiovascular conditions. This study aims to assess the association between comorbid depression and health-promoting behavior in middle-aged and older Australian women with hypertension or heart disease.

METHODS

Data are from a subset of 45 and Up Study participants with diagnosed chronic illness (n = 1,925). Health behaviors including smoking status, alcohol consumption, and physical activity were assessed. Associations of depression with health behaviors in women with hypertension or heart disease were analyzed using unadjusted and adjusted (for chronic conditions and demographic measures) logistic regression models.

RESULTS

A total of 666 women with hypertension and 220 women with heart disease were included in the analysis. In adjusted analyses, women with hypertension and comorbid depression were 2.36 (95% confidence interval, 1.02-5.46) times more likely to be risky or high-risk drinkers and 55% (adjusted odds ratio, 0.45; 95% confidence interval, 0.27-0.73) less likely to be highly physically active, compared with women without depression. Women with heart disease and comorbid depression were 65% (adjusted odds ratio, 0.35; 95% confidence interval, 0.12-0.95) less likely to be highly physically active, compared with women without depression.

CONCLUSIONS

This study provides the first data indicating that depression may be a barrier to health-promoting behavior in middle-aged and older women with hypertension or heart disease. Given that physical inactivity and risky alcohol consumption are important risk factors for aggravation of cardiologic conditions, health-promoting behaviors should be specifically targeted in the treatment of women with comorbid depression.

Early childhood and adolescent risk factors for psychotic depression in a general population birth cohort sample

BACKGROUND AND PURPOSE

In the group of severe mental disorders, psychotic depression (PD) is essentially under-researched. Knowledge about the risk factors is scarce and this applies especially to early risk factors. Our aim was to study early childhood and adolescent risk factors of PD in a representative birth cohort sample with a follow-up of up to 50 years.

METHODS

The study was carried out using the Northern Finland Birth Cohort 1966 (NFBC 1966). We used non-psychotic depression (NPD) (n = 746), schizophrenia (SZ) (n = 195), psychotic bipolar disorder (PBD) (n = 27), other psychoses (PNOS) (n = 136) and healthy controls (HC) (n = 8200) as comparison groups for PD (n = 58). We analysed several potential early risk factors from time of birth until the age of 16 years.

RESULTS

The main finding was that parents' psychiatric illness [HR 3.59 (1.84-7.04)] was a risk factor and a high sports grade in school was a protective factor [HR 0.29 (0.11-0.73)] for PD also after adjusting for covariates in the multivariate Cox regression model. Parental psychotic illness was an especially strong risk factor for PD. The PD subjects had a parent with psychiatric illness significantly more often (p < 0.05) than NPD subjects. Differences between PD and other disorder groups were otherwise small.

CONCLUSIONS

A low sports grade in school may be a risk factor for PD. Psychiatric illnesses, especially psychoses, are common in the parents of PD subjects. A surprisingly low number of statistically significant risk factors may have resulted from the size of the PD sample and the underlying heterogeneity of the etiology of PD.

Workplace-Related Interpersonal Group Psychotherapy to Improve Life at Work in Individuals With Major Depressive Disorders: A Randomized Interventional Pilot Study

OBJECTIVES

Individuals suffering from major depressive disorder (MDD) often report workplace-related stress as the major cause of their disorder. Accordingly, workplace-related stress was established as a fifth psychosocial problem area of Interpersonal Psychotherapy (workplace-related Interpersonal Psychotherapy, W-IPT). The aim of the study was to investigate the influence of W-IPT on depressive symptoms and on workplace-related issues in individuals with MDD compared to a treatment-as-usual (TAU) condition.

METHODS

A total of 27 individuals with MDD (mean age = 43 years, 48% males) were randomly assigned either to eight weekly group sessions of W-IPT or to the TAU condition. At baseline, 8 weeks later at the end of the intervention, and 20 weeks later at follow-up, the Hamilton Rating Scale for Depression was conducted. In addition, the participants completed the Beck Depression Inventory, the Work Ability Index (WAI), the Return to Work Attitude (RTW-SE), and the Insomnia Severity Index (ISI).

RESULTS

Symptoms of depression in experts' ratings as well as in self-rated ratings decreased over time, but more so in the W-IPT condition compared to the TAU condition [experts rating: large effect size (d = 1.25) and self-assessment: large effect sizes (d = 0.94)]. The subjective ability to work (WAI) [medium effect size (d = 0.68)], self-efficacy to returning to work RTW-SE [medium effect size (d = 0.57)], and subjective symptoms of insomnia (ISI) [large effect size (d = 1.15)] increased over time, but again more so in the W-IPT condition compared to the TAU condition. The effects of the intervention remained stable from the end of the intervention to follow-up.

CONCLUSIONS

The pattern of results of this pilot study suggests that a newly established fifth IPT focus on workplace-related stress appeared to be particularly efficient in individuals with MDD due to work-related stress in reducing depressive symptoms and reducing sleep complaints as well as in improving occupational outcomes.