Exercise for depression

Treatment resistant late-life depression: A narrative review of psychosocial risk factors, non-pharmacological interventions, and the role of clinical phenotyping

BACKGROUND

Treatment resistant depression (TRD) is a subset of major depressive disorder (MDD) in which symptoms do not respond to front line therapies. In older adults, the assessment and treatment of TRD is complicated by psychosocial risk factors unique to this population, as well as a relative paucity of research.

METHODS

Narrative review aimed at (1) defining TRLLD for clinical practice and research; (2) describing psychosocial risk factors; (3) reviewing psychological and non-pharmacological treatments; (4) discussing the role of clinical phenotyping for personalized treatment; and (5) outlining research priorities.

RESULTS

Our definition of TRLLD centers on response to medication and neuromodulation in primary depressive disorders. Psychosocial risk factors include trauma and early life adversity, chronic physical illness, social isolation, personality, and barriers to care. Promising non-pharmacological treatments include cognitive training, psychotherapy, and lifestyle interventions. The utility of clinical phenotyping is highlighted by studies examining the impact of comorbidities, symptom dimensions (e.g., apathy), and structural/functional brain changes.

LIMITATIONS

There is a relative paucity of TRLLD research. This limits the scope of empirical data from which to derive reliable patterns and complicates efforts to evaluate the literature quantitatively.

CONCLUSIONS

TRLLD is a complex disorder that demands further investigation given our aging population. While this review highlights the promising breadth of TRLLD research to date, more research is needed to help elucidate, for example, the optimal timing for implementing risk mitigation strategies, the value of collaborative care approaches, specific treatment components associated with more robust response, and phenotyping to help inform treatment decisions.

Impact of leisure physical activity and resistance exercise on the prevalence of depressive symptoms in Korean adults: Analysis of the Korean National Health and Nutrition Examination Survey

BACKGROUND

Various physical activity (PA) guidelines recommend leisure PA and resistance exercise (RE). However, the impact of PA and RE on the prevalence of depressive symptoms remains unclear. We investigated whether meeting PA and RE guidelines is associated with the prevalence of depressive symptoms using nationally representative samples.

METHODS

We analyzed data from 11,829 (5111 male and 6718 female) participants aged 19+ years in the Korean National Health and Nutrition Examination Survey (2016 and 2018). Those with doctor's diagnosis of depression or with a cut-off score of ≥11 on the Patient Health Questionnaire-9 were defined as having depressive symptoms. PA and RE were measured using a validated Global PA Questionnaire. Logistic regression analysis was used to examine the association between participating in leisure PA, simultaneously meeting RE guidelines, and experiencing depressive symptoms.

RESULTS

Those who participated in leisure PA and met RE guidelines had a lower prevalence of depressive symptoms than those who did not (p for trend <0.001). After adjusting for covariates, those who participated in leisure PA and met RE guideline were significantly less likely to have depressive symptoms in male (OR = 0.52, 95 % CI 0.32-0.84) and female (OR = 0.71, 95 % CI 0.48-1.06), compared with those who did not participate in leisure PA but also did not meet RE guideline.

LIMITATIONS

The cross-sectional nature of the data prevented causal claims.

CONCLUSIONS

Participation in leisure PA and RE was associated with a lower prevalence of depressive symptoms. This suggests both leisure PA and RE should be encouraged as effective means for preventing depression.

Step away from depression-results from a multicenter randomized clinical trial with a pedometer intervention during and after inpatient treatment of depression

Evidence for the effectiveness of physical activity (PA) in the treatment of depression prevails for outpatients with mild and moderate symptom levels. For inpatient treatment of severe depression, evidence-based effectiveness exists only for structured and supervised group PA interventions. The Step Away from Depression (SAD) study investigated the effectiveness of an individual pedometer intervention (PI) combined with an activity diary added to inpatient treatment as usual (TAU). In this multicenter randomized controlled trial, 192 patients were randomized to TAU or TAU plus PI. The two primary outcomes at discharge were depression-blindly rated with the Montgomery-Åsberg Depression Rating Scale (MADRS)-and average number of daily steps measured by accelerometers. Secondary outcomes were self-rated depression and PA, anxiety, remission and response rates. Multivariate analysis of variance (MANOVA) revealed no significant difference between both groups for depression and daily steps. Mean MADRS scores at baseline were 29.5 (SD = 8.3) for PI + TAU and 28.8 (SD = 8.1) for TAU and 16.4 (SD = 10.3) and 17.2 (SD = 9.9) at discharge, respectively. Daily steps rose from 6285 (SD = 2321) for PI + TAU and 6182 (SD = 2290) for TAU to 7248 (SD = 2939) and 7325 (SD = 3357). No differences emerged between groups in secondary outcomes. For severely depressed inpatients, a PI without supervision or further psychological interventions is not effective. Monitoring, social reinforcement and motivational strategies should be incorporated in PA interventions for this population to reach effectiveness.

Unpacking differences in post-exercise affective experiences between physically underactive and active individuals

BACKGROUND

Affective response to exercise (i.e., how individuals feel during- and post-exercise) as well as post-behavioral evaluations of affective experiences with exercise (i.e., reflecting on the experience after engaging in exercise) may be important determinants of regular exercise.

PURPOSE

We compared post-exercise affective response and post-behavioral evaluations of exercise between a physically active and underactive group. Physically active (n = 32) and underactive (n = 25) participants completed a 10-minute treadmill bout of vigorous exercise and reported affective valence, positive activated affect, negative activated affect, calmness, fatigue and relief at various points during and/or after the bout.

RESULTS

As expected, both groups reported an improvement in affective valence immediately post-exercise (ps < 0.001). This improvement in affective valence was associated with a concurrent decrease in negative affect (ps < 0.05) for the physically underactive group and was only associated with a concurrent increase in positive affect (ps < 0.02) for the active group. There were significant differences between physically active and underactive groups in pre-post exercise changes in positive activated affect (ps < 0.005). The underactive group reported greater relief than the active group at all-post exercise time-points (ps < 0.05).

CONCLUSIONS

These findings have implications for understanding post-exercise affective response and post-behavioral evaluations of exercise and for interventions directed at influencing the post-exercise affective response and behavioral evaluations of exercise in physically underactive individuals.

Effects of Cortisol Administration on Resting-State Functional Connectivity in Women with Depression

Previous resting-state functional connectivity (rsFC) research has identified several brain networks impacted by depression and cortisol, including default mode (DMN), frontoparietal (FPN), and salience networks (SN). In the present study, we examined the effects of cortisol administration on rsFC of these networks in individuals varying in depression history and severity. We collected resting-state fMRI scans and self-reported depression symptom severity for 74 women with and without a history of depression after cortisol and placebo administration using a double-blind, crossover design. We conducted seed-based rsFC analyses for DMN, FPN, and SN seeds to examine rsFC changes after cortisol vs. placebo administration in relation to depression history group and severity. Results revealed a main effect of depression group, with lower left amygdala (SN)-middle temporal gyrus connectivity in women with a history of depression. Cortisol administration increased insula (SN)-inferior frontal gyrus and superior temporal gyrus connectivity. We also found that greater depression severity was associated with increased PCC (DMN)-cerebellum connectivity after cortisol. These results did not survive Bonferroni correction for seed ROIs and should be interpreted with caution. Our findings indicate that acute cortisol elevation may normalize aberrant connectivity of DMN and SN regions, which could help inform clinical treatments for depression.

Changes in physical activity and the risk of heart failure in newly diagnosed patients with depression: A nationwide cohort study

BACKGROUND

Depression is known to increase the risk of heart failure (HF), and physical activity could be a potential mediator of their linkage. In this study, we examined the risk of incident HF according to changes in the level of physical activity before and after the diagnosis of depression.

METHODS

A South Korean National Health Insurance Sharing Service database was used. A total of 1,405,655 patients with newly diagnosed depression were included in the analyses. According to the changes in physical activity based on the recommended level of regular physical activity, participants were divided into four groups: never, beginning, maintenance, and discontinuation. The main outcome was the occurrence of HF.

RESULTS

During the average follow-up period of 5.28 years (SD, 2.00 years), 69,338 participants were diagnosed with HF, with an incidence rate of 9.34 per 1000 person-years. Compared to the never group, the beginning group showed a decreased risk of HF (aHR, 0.88; 95% CI, 0.86-0.90). Compared to the maintenance group, the discontinuation group showed an increased risk of HF (aHR, 1.16; 95% CI, 1.11-1.20).

CONCLUSIONS

In the patients with depression, beginning regular physical activity was associated with a decreased risk of HF, and discontinuing regular physical activity was associated with an increased risk.

Effect of acute and long-term exercise on leptin levels in depressed outpatients

BACKGROUND

Depression is a leading cause of disability worldwide and a significant contributor to the global burden of disease. Altered leptin levels are known to be associated with depressive symptoms, however discrepancies in the results of increased or decreased levels exist. Due to various limitations associated with commonly used antidepressant drugs, alternatives such as exercise therapy are gaining more importance. Therefore, the current study investigates whether depressed patients have higher leptin levels compared to healthy controls and if exercise is efficient to reduce these levels.

METHODS

Leptin levels of 105 participants with major depressive disorder (MDD; 45.7% female, age mean ± SEM: 39.1 ± 1.0) and 34 healthy controls (HC; 61.8% female, age mean ± SEM: 36.0 ± 2.0) were measured before and after a bicycle ergometer test. Additionally, the MDD group was separated into three groups: two endurance exercise intervention groups (EX) differing in their intensities, and a waiting list control group (WL). Leptin levels were measured pre and post a 12-week exercise intervention or the waiting period.

RESULTS

Baseline data showed no significant differences in leptin levels between the MDD and HC groups. As expected, correlation analyses displayed significant relations between leptin levels and body weight (HC: r = 0.474, p = 0.005; MDD: r = 0.198, p = 0.043) and even more with body fat content (HC: r = 0.755, p < 0.001; MDD: r = 0.675, p < 0.001). The acute effect of the bicycle ergometer test and the 12-week training intervention showed no significant changes in circulating leptin levels.

CONCLUSION

Leptin levels were not altered in patients with major depression compared to healthy controls and exercise, both the acute response and after 12 weeks of endurance training, had no effect on the change in leptin levels.

TRIAL REGISTRATION

The study was registered at the German register for clinical studies (DRKS) and the International Clinical Trials Registry Platform of the World Health Organization https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00008869 on 28/07/2015.

Psychiatric rehabilitation and cognitive deficit for treatment-resistant depression

Patients with TRD often experience persistent impairment of affective, psychosocial, and cognitive function, which impedes their recovery. The continuation of pharmacotherapy for patients with TRD remains the cornerstone of functional recovery. Cognitive dysfunction is prevalent in patients with MDD and may make patients' depressive symptoms and psychosocial functioning worse, even in the remitted stage of illness. Deficits can manifest not only in specific cognitive domains but also in global cognitive function, which may reflect underlying persistent pathophysiological changes. Compared with nontreatment-resistant patients with MDD, patients with TRD exhibit greater subjective and objective cognitive impairment, which possibly contributes to a greater adverse impact on daily functioning. Cognitive and psychosocial remission should be a goal in treating MDD. How to appropriately and individualized perform pharmacological intervention, psychotherapy, neuromodulation, cognitive remediation or other rehabilitation treatment programs is a critical step to achieve our goal. Integrating multiple interventions that engage multiple physiological systems with a multidisciplinary team warrants increased attention, and personalized therapeutic programs may facilitate the complete restoration of patients' everyday functioning.

Mental and Physical Health, Psychosocial Maturity, and Desistance in Young Adulthood

Recent theoretical and empirical work has drawn increased attention to the role that mental and physical health can play in promoting life-course success and desistance from crime. This study integrates literature on youth development with the health-based desistance framework to investigate a key developmental pathway through which health influences desistance among system-involved youth. Using multiple waves of data from the Pathways to Desistance Study, the current study uses generalized structural equation modeling to examine whether and to what extent mental and physical health influence offending and substance use directly and indirectly through psychosocial maturity. Findings indicate that both depression and poor health stall the development of psychosocial maturity, and that those with higher psychosocial maturity are less likely to engage in offending and substance use. The model provides general support for the health-based desistance framework, finding an indirect process linking better health states to normative developmental desistance processes. Results hold important implications for the development of age-graded policies and programs geared toward promoting desistance among serious adolescent offenders both within correctional and community settings.

Exercise as therapy for neurodevelopmental and cognitive dysfunction in people with a Fontan circulation: A narrative review

People with a Fontan circulation are at risk of neurodevelopmental delay and disability, and cognitive dysfunction, that has significant implications for academic and occupational attainment, psychosocial functioning, and overall quality of life. Interventions for improving these outcomes are lacking. This review article discusses current intervention practices and explores the evidence supporting exercise as a potential intervention for improving cognitive functioning in people living with a Fontan circulation. Proposed pathophysiological mechanisms underpinning these associations are discussed in the context of Fontan physiology and avenues for future research are recommended.

Do the WHO-ICF personal factors "age" and "sex" impact limited activity and restricted participation category profiles differently between younger and older women and men in multimodal chronic back pain rehabilitation?

PURPOSE

To investigate if the International Classification of Functioning and Health (ICF) context factors "age" and "sex" would impact the disablement and respective improvement with rehabilitation defined with the ICF core set for chronic low back pain (cLBP). Furthermore, associations between limitations/restrictions and measures of body function or quality of life were of interest.

MATERIALS AND METHODS

One thousand five hundred and twelve employed cLBP patients who completed 6 months of outpatient rehabilitation and for whom complete assessments were available before and after rehabilitation. Rehabilitation comprised of progressive resistance training, psychological counseling, and educational sessions. Main outcome measures were the ICF-activity/participation core categories automatically predicted from random forests and utilizing information from the Roland Morris Disability Questionnaire and Pain Disability Index.

RESULTS

Generalized linear-mixed models revealed that upon completion of rehabilitation the presence of a limitation within the ICF activity "walking" significantly decreased with significant between-group differences. The category "doing housework" demonstrated gender-specific differences, and both gender- and age-specific differences were observed for work-related participation categories. There were no meaningful associations between ICF limitation/restriction categories and body function measures (point-biserial/Spearman's correlations).

CONCLUSIONS

The personal factors "age" and "sex" impact some ICF limitation/restriction categories in cLBP; appropriately addressing these personal features could further improve phase III rehabilitation outcome.Implications for rehabilitationConsistent with calls to explore the age and sex/gender influence on health and disease, little is known how these factors affect the disablement of individuals with chronic back pain.The factors "age" and "sex" drive differences in some categories within the ICF activity/restriction categories.If age- and gender-specific features in activities and participation are not appropriately addressed through interventions, rehabilitation outcome may remain suboptimal in cLBP.

Influence of Initial Severity of Depression on the Effectiveness of a Multimodal Therapy on Depressive Score, Heart Rate Variability, and Hemodynamic Parameters

Depression is a major cause of disability among populations worldwide. Apart from primary symptoms, depressed patients often have a higher cardiovascular risk profile. Multimodal therapy concepts, including exercise, have emerged as promising approaches that not only improve depressive symptoms but also have a positive impact on cardiovascular risk profile. However, controversies have arisen concerning the influence of baseline severity on the effects of therapy concepts for this demographic. This study assessed whether pretreatment severity moderates psychological and physiological treatment outcomes of a multimodal therapy. A total of 16 patients diagnosed with mild depression (MD) and 14 patients diagnosed with severe depression (SD) took part in a 3-month outpatient multimodal treatment therapy. Before and after the treatment, depression score (Beck Depression Inventory (BDI)), peripheral systolic (pSBP) and diastolic (pDBP) blood pressure, central systolic (cSBP) and diastolic (cDBP) blood pressure, pulse wave velocity (PWV), heart rate (HR), and parasympathetic parameters of heart rate variability (RMSSD) were assessed. Significant time effects were detected for BDI (−20.0 ± 11.6, p > 0.001, η2 = 0.871), pSBP (−4.7 ± 6.8 mmHg, p < 0.001, η2 = 0.322), pDBP (−3.5 ± 6.9 mmHg, p = 0.01, η2 = 0.209), cSBP (−4.8 ± 6.5 mmHg, p < 0.001, η2 = 0.355), cDBP (−3.6 ± 6.8 mmHg, p = 0.008, η2 = 0.226), PWV (−0.13 ± 0.23 m/s, p = 0.008, η2 = 0.229), HR (4.3 ± 8.8 min−1, p = 0.015, η2 = 0.193), RMSSD (−12.2 ± 23.9 ms, p = 0.017, η2 = 0.251), and and SDNN (10.5 ± 17.8 ms, p = 0.005, η2 = 0.330). Significant time × group interaction could be revealed for BDI (p < 0.001, η2 = 0.543), with patients suffering from SD showing stronger reductions. Pretreatment severity of depression has an impact on the effectiveness of a multimodal therapy regarding psychological but not physiological outcomes.

Social participation and depressive symptoms in older African American cancer survivors: a comparison with non-cancer subjects

OBJECTIVES

African Americans are differentially affected by most cancers compared to other racial groups. Social participation has demonstrated beneficial effects on mental health in older adults with a history of cancer. The purpose of the present study is to examine and compare the effects of specific social participation activities on depressive symptoms among older African Americans with and without a history of cancer.

METHOD

The study sample included 2,000 older African Americans selected from the National Health and Aging Trends Study. Waves from 2011 to 2018 were used. Mixed-effects logistic regressions were applied to examine the effects of four social participation activities on depressive symptoms among older African Americans with or without a history of cancer.

RESULTS

Among older African American who had a history of cancer, visiting family and friends and attending religious services were related to lower odds of depressive symptoms. However, among older African Americans without a history of cancer, joining organized activities and going out for enjoyment predicted lower odds of depressive symptoms.

CONCLUSION

Older African Americans with a history of cancer tend to benefit from visiting family and friends and attending religious services in coping with depressive symptoms. Mental health services for this group could focus interventions on promoting social participation activities with family, friends, and religious congregants.

Enhancing Mental Health, Well-Being and Active Lifestyles of University Students by Means of Physical Activity and Exercise Research Programs

Mental disorders (e.g., depression) and sedentary behavior are increasing, also among emerging adults. One particular target group of emerging adults with high sitting times and vulnerability to mental disorders are university students. In particular, anxiety and depressive symptoms as well as stress symptoms are very common among university students. The present manuscript discusses whether physical activity and exercise interventions can help to promote the mental health of emerging adults such as university students. The manuscript will summarize current scientific evidence and based on this evidence, introduce an university-based scientific research project that investigates if physical activity, exercise interventions and acute bouts of exercise of low- to moderate intensity can buffer perceived stress, alleviate mental health symptoms and strengthen well-being (psychologically and physiologically) among university students by positively influencing depressive and anxiety symptoms, perceived stress and emotion perception, body awareness and subjective well-being including overall quality of life. The research project, its concept, multimethod approach, and first results from available studies are discussed in relation to current scientific evidence, health care needs and future developments. The results from the studies conducted within the research project so far and that are briefly summarized in this manuscript suggest that physical activity, mental health and well-being are positively related, also in university students as an important group of emerging adults. The results further suggest that exercise interventions comprising aerobic exercises of low- to moderate intensity may work best to improve mental health (alleviate depressive symptoms and perceived stress) among university students after a few weeks of intervention. In addition, acute bouts of certain types of exercises (yoga in particular) seem to be particularly effective in changing perception of bodily signals, cardiac activity and emotion processing immediately after the exercise. The results underscore the importance of systematic investigations of the combined examination of psychological and physiological factors that promote an active lifestyle and that strengthen mental health and well-being (psychologically and physiologically) among emerging adults such as university students.

Digital interventions to address mental health needs in colleges: Perspectives of student stakeholders

Objective

The need for clinical services in U.S. colleges exceeds the supply. Digital Mental health Interventions (DMHIs) are a potential solution, but successful implementation depends on stakeholder acceptance. This study investigated the relevance of DMHIs from students' perspectives.

Methods

In 2020-2021, an online cross-sectional survey using mixed methods was conducted with 479 students at 23 colleges and universities. Respondents reported views and use of standard mental health services and DMHIs and rated the priority of various DMHIs to be offered through campus services. Qualitative data included open-ended responses.

Findings

Among respondents, 91% reported having experienced mental health problems, of which 91% reported barriers to receiving mental health services. Students highlighted therapy and counseling as desired and saw flexible access to services as important. With respect to DMHIs, respondents had the most experience with physical health apps (46%), mental health questionnaires (41%), and mental well-being apps (39%). Most were unaware of or had not used apps or self-help programs for mental health problems. Students were most likely to report the following DMHIs as high priorities: a crisis text line (76%), telehealth (66%), websites for connecting to services (62%), and text/messaging with counselors (62%). They considered a self-help program with coach support to be convenient but some also perceived such services to be possibly less effective than in-person therapy.

Conclusions

Students welcome DMHIs on campus and indicate preference for mental health services that include human support. The findings, with particular focus on characteristics of the DMHIs prioritized, and students' awareness and perceptions of scalable DMHIs emphasized by policymakers, should inform schools looking to implement DMHIs.

The relationship between domain-specific physical activity and depressive symptoms in Korean adults: Analysis of the Korea National Health and Nutrition Examination Survey

BACKGROUND

This study aimed to investigate the associations of domain-specific physical activity (PA) with the prevalence of depressive symptoms.

METHODS

We analyzed data from 11,679 (5,056 men and 6,623 women) participants aged ³19 years in the Korea National Health and Nutrition Examination Survey (2016 and 2018 waves). Depressive symptoms were measured using the Korean version of the Patient Health Questionnaire-9 (PHQ-9), with a cut-off score for depression of 11. The participants were first categorized by sex, and then by their PA level in different PA domains into three different groups. We examined the correlations between domain-specific PA and depressive symptoms using logistic regression analysis after controlling for confounders.

RESULTS

Total amount of PA was not associated with depressive symptoms. However, in both sexes, those high in leisure and transport PA had lower levels of depressive symptoms compared with those with no leisure and transport PA (p for trend <0.001). After adjusting for covariates, those high in work PA showed a significantly higher likelihood of having depressive symptoms both in male (OR= 2.74, 95% CI 1.56-4.82) and female participants (OR= 2.84, 95% CI 1.70-4.49), compared to those with no work PA.

LIMITATION

Cross-sectional nature of the data prevents causal associations.

CONCLUSIONS

Although the total amount of PA participation was not associated with depressive symptoms, domain-specific PAs were differently associated with depressive symptoms. Specifically, higher amount of work PA was significantly associated with higher prevalence of depressive symptoms; this topic deserves further attention and future investigation.

A framework for incorporating physical activity in treatment: Competencies, guidelines, and implications for family therapists

Physical activity can have a profound impact on the cognitive, emotional, and social aspects of our clients' lives, and can even boost and sustain therapy outcomes. And yet, family therapists may not be trained or educated in the importance of physical activity nor how to assess, educate, and collaborate with health professionals to incorporate physical activity in treatment. As the evidence grows on the connection between physical activity and biopsychosocial functioning and more family therapists enter medical and healthcare settings, a framework for physical activity competencies is needed. As such, the purpose of this conceptual and empirical review paper is to (a) review the important brain-boosting benefits of physical activity for mental, cognitive, and social health, (b) provide a framework for the domains for family therapists for incorporating exercise in assessment and treatment, and finally, (c) outline recommendations for practice, education and supervision, and research for family therapists.

COVID19 Pandemic and Physical Activity: An Observational Study on Sleep Quality and Anxiety

Mental alterations were described during the COVID-19 pandemic and sleep deprivation has been reported as a consequence of social isolation. In Italy, the COVID-19 pandemic spread out at the beginning of 2020 determining severe lockdown periods. The aim of our study was to observe the effects of lockdown on sleep and anxiety in trained non-professional subjects and professional athletes who continued to train during the lockdown period. Forty-six subjects (21 trained non-professional subjects and 25 professional athletes) were recruited from a variety of team and individual sports to complete a battery of previously validated and widely used questionnaires assessing psychometric and anthropometric parameters, physical activity levels, lifestyle habits, and sleep quality. Subjects were aged 27.0 ± 5.14. All items were evaluated as percentages and chi-square and Fisher’s exact tests were performed, as appropriate. Our data showed that the prevalence of the difficulty of falling asleep (over 30%), the tendency of nocturnal awakenings (over 30%), and moderate anxiety (over 38%) were at the same extent in the two groups. Of the professional athletes, 72.73% declared snoring during sleep vs 42.86% of non-professional subjects. No other significant differences were found between the two groups except for the perception of being constant in daily activity, significantly more reported by trained subjects (p < 0.005). Our data show a similar scenario of anxiety and sleep disturbances for the two groups, suggesting that lockdown by the COVID-19 pandemic has partially mitigated the known beneficial effects due to physical activity on mental health and sleep quality. Further analyses are necessary to define the associated risk factors.

Compulsive exercise among college students: 5-year time trends in prevalence and demographic, substance use, and mental health correlates

PURPOSE

To provide 5-year time trends in prevalence and demographic, substance use, and mental health correlates of compulsive exercise among a national sample of college men and women.

METHODS

We analyzed 4 academic survey years (2016-2020; N = 8251) of the national (USA) Healthy Minds Study. Compulsive exercise was measured by self-report of any occurrence of "compulsive" exercise in the past 4 weeks. Unadjusted prevalence of compulsive exercise in the past 4 weeks was estimated across the 4 survey years by sex. Multiple logistic regression analyses were conducted among the pooled sample and stratified by sex to estimate the associations between compulsive exercise in the past 4 weeks and demographic, substance use, and mental health correlates.

RESULTS

Among the pooled sample, 11% (95% confidence interval [CI] 9.60-12.42%) of men and 17% (95% CI 15.86-18.24%) of women reported compulsive exercise in the past 4 weeks. Prevalence across the 4 survey years remained stable among men and women. Higher body mass index was associated with greater odds of any compulsive exercise in the past 4 weeks among men, while any sports participation was associated with greater odds of any compulsive exercise in the past 4 weeks among women. Compulsive exercise in the past 4 weeks was associated with greater odds of all mental health symptoms and illicit drug use among men and women, and higher odds of alcohol use among women.

CONCLUSION

Compulsive exercise is relatively common among college men and women and is associated with substance use behaviors and poor mental health symptoms.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

Empowerment In The Treatment Of Fatigue In Breast Cancer Patients

This review aimed at providing a summary of a collection of literature that covers breast cancer and related phenomena, namely fatigue and the disruption of self-esteem and body image that can occur when a cancer diagnosis is given. As the most common symptom reported by survivors, fatigue is a unique personal symptom that burdened survivors, a consequence as well as an antecedent. Fatigue in cancer is caused by disease processes as well as treatment side effects and becomes a serious problem compared to pain and nausea due to limited physical function, and psychological and social welfare. Facing the problem of fatigue, and poor self-esteem and body image in nursing science contributes to the empowerment of survivors; this is achieved through nursing processes and is a standard that can be used to solve fatigue problems.

A review of effects of calorie restriction and fasting with potential relevance to depression

In recent years, there has been a great deal of interest in the effects of calorie reduction (calorie restriction) and fasting on depression. In the current paper, we have reviewed the literature in this area, with discussion of the possible neurobiological mechanisms involved in calorie restriction and intermittent fasting. Factors which may play a role in the effects of these dietary manipulations on health include changes involving free fatty acids, ketone bodies, neurotransmitters, cyclic adenosine monophosphate response element binding protein (CREB), brain-derived neurotrophic factor (BDNF), cytokines, orexin, ghrelin, leptin, reactive oxygen species and autophagy. Several of these factors are potential contributors to improving symptoms of depression. Challenges encountered in research on calorie restriction and intermittent fasting are also discussed. Although much is now known about the acute effects of calorie restriction and intermittent fasting, further long term clinical studies are warranted.

Exercise rather than fluoxetine promotes oligodendrocyte differentiation and myelination in the hippocampus in a male mouse model of depression

Although selective serotonin reuptake inhibitor (SSRI) systems have been meaningfully linked to the clinical phenomena of mood disorders, 15-35% of patients do not respond to multiple SSRI interventions or even experience an exacerbation of their condition. As we previously showed, both running exercise and fluoxetine reversed depression-like behavior. However, whether exercise reverses depression-like behavior more quickly than fluoxetine treatment and whether this rapid effect is achieved via the promotion of oligodendrocyte differentiation and/or myelination in the hippocampus was previously unknown. Sixty male C57BL/6 J mice were used in the present study. We subjected mice with unpredictable chronic stress (UCS) to a 4-week running exercise trial (UCS + RN) or intraperitoneally injected them with fluoxetine (UCS + FLX) to address these uncertainties. At the behavioral level, mice in the UCS + RN group consumed significantly more sugar water in the sucrose preference test (SPT) at the end of the 7th week than those in the UCS group, while those in the UCS + FLX group consumed significantly more sugar water than mice in the UCS group at the end of the 8th week. The unbiased stereological results and immunofluorescence analyses revealed that running exercise, and not fluoxetine treatment, increased the numbers of CC1⁺ and CC1⁺/Olig2⁺/BrdU⁺ oligodendrocytes in the CA1 subfield in depressed mice exposed to UCS. Moreover, running exercise rather than fluoxetine increased the level of myelin basic protein (MBP) and the G-ratio of myelinated nerve fibers in the CA1 subfield in the UCS mouse model. Unlike fluoxetine, exercise promoted hippocampal myelination and oligodendrocyte differentiation and thus has potential as a therapeutic strategy to reduce depression-like behaviors induced by UCS.

Physical activity changes during behavioral weight loss treatment by Latinx patients with obesity with and without binge eating disorder

OBJECTIVE

This secondary analysis examined physical activity (PA) changes and their prognostic significance among Latinx patients with obesity, with and without binge eating disorder (BED), who participated in a randomized, placebo-controlled trial testing the addition of orlistat to behavioral weight-loss (BWL) treatment in a "real-world" clinical setting.

METHODS

In this randomized controlled trial at a community mental health center serving economically disadvantaged Spanish-speaking-only Latinx patients, 79 patients with obesity (40 with BED and 39 without BED) received BWL treatment and were randomized to orlistat or placebo. PA, weight, depression, and binge eating were assessed at baseline, posttreatment (end of treatment [4 months]), and the 6-month follow-up (10 months after baseline).

RESULTS

PA was low at baseline (9.3% categorized as "active"), increased during treatment (32.9% categorized as "active" at posttreatment), and declined from posttreatment to the 6-month follow-up (28.2% classified as "active"). At baseline, PA was lower among patients with BED than those without BED. Changes in PA during and after treatment did not differ by BED status or medication condition. PA change was associated with reduced depression but not weight loss.

CONCLUSIONS

Latinx patients with obesity receiving BWL treatment achieved significant, albeit modest, increases in PA. Although PA changes were not associated with weight loss, they were associated with reduced depression. Identifying methods to increase PA further is necessary.

Effects of a group-based lifestyle medicine for depression: A pilot randomized controlled trial

Given the growing evidence that a range of lifestyle factors are involved in the etiology of depression, a ‘lifestyle medicine’ approach can be potentially safe and cost-effective to prevent or treat depression. To examine the effects and acceptability of a group-based, integrative lifestyle medicine intervention as a standalone treatment for managing depressive symptoms, a pilot randomized controlled trial (RCT) was conducted in a Chinese adult population in 2018. Participants (n = 31) with PHQ-9 score above the cut-off of ≥ 10, which was indicative of moderate to severe depression, were recruited from the general community in Hong Kong and randomly assigned to lifestyle medicine group (LM group) or care-as-usual group (CAU group) in a ratio of 1:1. Participants in the LM group received 2-hour group sessions once per week for six consecutive weeks, which covered diet, exercise, mindfulness, psychoeducation, and sleep management. Linear mixed-effects model analyses showed that the LM group had a significant reduction in PHQ-9 scores compared to the CAU group at immediate posttreatment and 12-week posttreatment follow-up (d = 0.69 and 0.73, respectively). Moreover, there were significantly greater improvements in anxiety, stress, and insomnia symptoms (measured by DASS-21 and ISI) at all time points in the LM group (d = 0.42–1.16). The results suggests that our 6-week group-based, integrative lifestyle intervention program is effective in lowering depressive, anxiety, stress, and insomnia symptoms in the Chinese population. Further studies in clinical populations with a larger sample size and longer follow-up are warranted.

Prevalence of depression and suicide ideation in Hong Kong doctors: a cross-sectional study

Depression amongst physicians can lead to poor individual and institutional outcomes. This study examined the prevalence and factors associated with depression and suicidal ideation amongst doctors in Hong Kong. Doctors who graduated from medical school at the University of Hong Kong between 1995 and 2014 were invited to participate in a survey measuring depressive symptoms, suicidal ideation and thoughts of self-harm, lifestyle behaviours, career satisfaction and socio-demographic characteristics. Data collection occurred between January and April 2016. The prevalence of screened-positive depression was 16.0% and 15.3% of respondents reported having suicidal ideation. Amongst those with positive depression screening scores, less than half reported having a diagnosed mood disorder. Sleeping fewer hours was associated with higher depression scores (P < 0.001) and an increased odds of meeting the cut-off for depression (P < 0.001). Factors associated with suicidal ideation included being unmarried (P = 0.012) and sleeping fewer hours (P = 0.022). Hong Kong doctors appear to have high rates of undiagnosed depression, and high levels of depressive symptoms and suicidal ideations. There is a need for greater awareness of the morbidity due to depression and to promote better mental health help-seeking among physicians. Barriers to mental health help-seeking need to be addressed and appropriate resources allocated to reduce suffering.

The Influence of Human Support on the Effectiveness of Digital Mental Health Promotion Interventions for the General Population

Mental wellbeing amongst the general population is languishing—exacerbated by the Coronavirus Disease 2019 (COVID-19) pandemic. Digital mental health promotion interventions, that improve mental health literacy and encourage adoption of evidence-informed practical strategies are essential. However, attrition and non-adherence are problematic in digital interventions. Human support is often applied as an antidote; yet, there is a paucity of randomized trials that compare different human support conditions amongst general population cohorts. Limited trials generally indicate that human support has little influence on adherence or outcomes in DMHPIs. However, providing participants autonomy to self-select automated support options may enhance motivation and adherence.

Descriptive Study of Employee Engagement With Workplace Wellness Interventions in the UK

OBJECTIVE

To explore sequential steps of employee engagement in wellness interventions and the impact of wellness interventions on employee health.

METHODS

Using previously collected survey data from 23,667 UK employees, we tabulated intervention availability, awareness, participation, and associated health improvement and compared engagement by participation and risk status.

RESULTS

Employees' awareness of wellness interventions at their workplaces was often low (mean 43.3%, range 11.6%-82.3%). Participation was highest in diet/nutrition initiatives (94.2%) and lowest in alcohol counseling and smoking cessation interventions (2.1%). Employees with health risks were less likely than lower-risk employees to report awareness, participation, and health improvements from wellness interventions addressing the relevant health concern.

CONCLUSION

Employers and policymakers should consider variation in intervention engagement as they plan and implement wellness interventions. Engaging employee populations with higher health risks requires a more targeted approach.

Brain-based mechanisms of late-life depression: Implications for novel interventions

Late-life depression (LLD) is a particularly debilitating illness. Older adults suffering from depression commonly experience poor outcomes in response to antidepressant treatments, medical comorbidities, and declines in daily functioning. This review aims to further our understanding of the brain network dysfunctions underlying LLD that contribute to disrupted cognitive and affective processes and corresponding clinical manifestations. We provide an overview of a network model of LLD that integrates the salience network, the default mode network (DMN) and the executive control network (ECN). We discuss the brain-based structural and functional mechanisms of LLD with an emphasis on their link to clinical subtypes that often fail to respond to available treatments. Understanding the brain networks that underlie these disrupted processes can inform the development of targeted interventions for LLD. We propose behavioral, cognitive, or computational approaches to identifying novel, personalized interventions that may more effectively target the key cognitive and affective symptoms of LLD.

Working Time Characteristics and Mental Health among Corrections and Transportation Workers

OBJECTIVES

Mental health disorders are a leading cause of work disability and while the psychosocial workplace environment plays a critical role, working time characteristics are also implicated. We sought to examine the association between working time characteristics and mental health in a cohort of two unionized, full-time worker populations, correctional supervisors, and transportation maintainers.

METHODS

Using a cross-sectional study design, we surveyed workers on working time characteristics across seven domains including length of the shift, the intensity or proximity of sequential shifts, the time of day, and social aspects of work hours including predictability, variability, control, and free time. Burnout symptoms (Oldenburg Burnout Inventory) and depressive symptoms (eight-item Centers for Epidemiologic Studies Depression Scale) were assessed along with the psychosocial work environment and health behaviors. We used log-binomial regression models to estimate prevalence ratios and 95% confidence intervals after adjusting for age, gender, and company.

RESULTS

A total of 318 workers were surveyed. The majority (72%) of workers reported a fixed shift. The prevalence of burnout symptoms was higher among workers reporting more frequent shift intensity (working 6 or more days in a row) (PR: 1.15, 95% CI: 1.01, 1.31; P = 0.04). Low psychological demands and high worker social support were associated with fewer burnout symptoms, independent of working time characteristics. The prevalence of depressive symptoms was higher in workers reporting more frequent unpredictable work (PR: 1.17, 95% CI: 1.01, 1.35; P = 0.04) and was lower among workers reporting increased schedule control (PR: 0.86, 95% CI: 0.77, 0.96; P = 0.01). Higher worker social support as well as sufficient sleep and adequate exercise were associated with fewer depressive symptoms, independent of working time characteristics.

CONCLUSIONS

Different working time characteristics were associated with work-related mental health (i.e. burnout) as well as general mental health (i.e. depressive symptoms). Work intensity was associated with the prevalence of burnout symptoms and the results suggest that the mechanism may be through the need for recovery from the psychosocial exposures of work. Both schedule control and predictability were associated with depressive symptoms and the results suggest that work-life imbalance and lack of recovery may be implicated. Comprehensive prevention policies that consider work organization along with the psychosocial work environment and work-life balance may help to improve workers' mental health.

Treatment targets of exercise for persistent non-specific low back pain: a consensus study

OBJECTIVES

Despite several hundred previous randomised controlled trials (RCTs), the key treatment targets of exercise for persistent non-specific low back pain (NSLBP) remain unclear. This study aimed to generate consensus about the key treatment targets of exercise interventions for patients with NSLBP.

DESIGN

Consensus was generated using modified nominal group technique in two, sequential, workshops. The results of a previous systematic review informed the first, national, workshop idea generation and the results of this workshop informed the second, international, workshop. The authors generated a starting list of 30 treatment targets from the systematic review. A pre-specified consensus threshold of 75% was used in the voting stage.

PARTICIPANTS

Workshop participants included people with experience of using exercise to manage their persistent NSLBP, clinicians who prescribe exercise for persistent NSLBP, and researchers who design and evaluate exercise interventions in RCTs. All participants generated, voted and ranked the treatment targets in each workshop using an online platform.

RESULTS

A total of 39 participants contributed to the consensus (15 in the national workshop and 24 in the international workshop), comprising two people with NSLBP, six clinicians and 31 researchers/clinicians. A total of 40 exercise treatment targets were generated, and 25 were retained after voting and ranking. The prioritised targets of exercise for persistent NSLBP were: improving function, improving quality of life, reducing pain, meeting patient-specific goals and reducing fear of movement.

CONCLUSIONS

Future RCTs of exercise should specify the targets of their exercise intervention and consider assessing these treatment targets as well as including mediation analyses.

Benefits and promotion of physical activity in rheumatoid arthritis

PURPOSE OF REVIEW

The aim of this article is to describe the benefits of physical activity and exercise on rheumatoid arthritis disease activity, functioning, and symptoms; and offer recommendations for promotion of physical activity and exercise among people with rheumatoid arthritis.

RECENT FINDINGS

In addition to well-known benefits of exercise such as improving cardiovascular health and metabolic syndrome and reducing obesity, exercise has consistently shown rheumatoid arthritis-specific benefits. Exercise and increases in physical activity improve clinically measured disease activity, reduce symptoms such as fatigue and pain, and improve function and mental health. In spite of these benefits, most people with rheumatoid arthritis are inactive. Patient barriers to engaging in physical activity may include fears of joint damage, rheumatoid arthritis symptoms, and lack of understanding that physical activity improves the symptoms that may be barriers. However, the greatest barrier to healthy levels of physical activity among individuals with rheumatoid arthritis appears to be the lack of direction from healthcare providers.

SUMMARY

Exercise is safe and highly beneficial for people with rheumatoid arthritis. Because receiving recommendations from healthcare providers may be the factor most strongly associated with engaging in physical activity or exercise, providers are encouraged to give patients positive messages about the benefits of physical activity and the extremely low risks of harm.

[Pain prevention in the primary care setting : Facts for resident physicians]

Based on health insurance data, approximately 37.4 million patients (46%) in Germany are diagnosed with "pain". The prevalence of patients with debilitating chronic pain is around 7.3%. From the health care perspective, and given the high socioeconomic relevance of chronic pain, effective preventive measures represent useful therapeutic approaches. In the context of pain medicine, primary prevention aims to avoid acute pain. Secondary prevention is targeted at preventing acute pain from turning into chronic pain. Tertiary prevention comprises measures to diminish pain-associated disability and impairment to everyday life. Finally, quaternary prevention focuses on avoiding medically non-indicated or unhelpful medical interventions. In addition to general approaches of pain prevention, such as detecting and treating of chronification factors (yellow, black and blue flags), the present article also describes educational and disease-specific approaches in musculoskeletal and neuropathic pain syndromes as well as headaches.

Customary physical activity and odds of depression: a systematic review and meta-analysis of 111 prospective cohort studies

Objective

To explore whether physical activity is inversely associated with the onset of depression, we quantified the cumulative association of customary physical activity with incident depression and with an increase in subclinical depressive symptoms over time as reported from prospective observational studies.

Design

Systematic review and meta-analysis.

Data sources

MEDLINE, PsycINFO, PsycARTICLES and CINAHL Complete databases, supplemented by Google Scholar.

Eligibility criteria

Prospective cohort studies in adults, published prior to January 2020, reporting associations between physical activity and depression.

Study appraisal and synthesis

Multilevel random-effects meta-analysis was performed adjusting for study and cohort or region. Mixed-model meta-regression of putative modifiers.

Results

Searches yielded 111 reports including over 3 million adults sampled from 11 nations in five continents. Odds of incident cases of depression or an increase in subclinical depressive symptoms were reduced after exposure to physical activity (OR, 95% CI) in crude (0.69, 0.63 to 0.75; I2=93.7) and adjusted (0.79, 0.75 to 0.82; I2=87.6) analyses. Results were materially the same for incident depression and subclinical symptoms. Odds were lower after moderate or vigorous physical activity that met public health guidelines than after light physical activity. These odds were also lower when exposure to physical activity increased over time during a study period compared with the odds when physical activity was captured as a single baseline measure of exposure.

Conclusion

Customary and increasing levels of moderate-to-vigorous physical activity in observational studies are inversely associated with incident depression and the onset of subclinical depressive symptoms among adults regardless of global region, gender, age or follow-up period.

A Handful of Details to Ensure the Experimental Reproducibility on the FORCED Running Wheel in Rodents: A Systematic Review

A well-documented method and experimental design are essential to ensure the reproducibility and reliability in animal research. Experimental studies using exercise programs in animal models have experienced an exponential increase in the last decades. Complete reporting of forced wheel and treadmill exercise protocols would help to ensure the reproducibility of training programs. However, forced exercise programs are characterized by a poorly detailed methodology. Also, current guidelines do not cover the minimum data that must be included in published works to reproduce training programs. For this reason, we have carried out a systematic review to determine the reproducibility of training programs and experimental designs of published research in rodents using a forced wheel system. Having determined that most of the studies were not detailed enough to be reproducible, we have suggested guidelines for animal research using FORCED exercise wheels, which could also be applicable to any form of forced exercise.

Physical Activity, Depression, and Antiretroviral Therapy Adherence Among People Living With HIV: A Mediation Analysis

The aim of our study was to explore the relationships between physical activity, depression, and antiretroviral therapy (ART) adherence. Data were obtained from a randomized controlled trial of people living with HIV (N = 658) in China. Ordinal regression and logistic regression analyses were performed to examine associations between ART adherence, depression, and physical activity. A better ART adherence was associated with higher levels of physical activity (adjusted odds ratio [aOR] = 1.36, 95% confidence interval [CI] = 1.02-1.80) and lower levels of depression (aOR = 0.95, 95% CI = 0.92-0.99). Higher levels of physical activity were also associated with lower levels of depression (aOR = 0.50, 95% CI = 0.32-0.76). Sobel Z test indicated the mediating effect of depression between physical activity and ART adherence (Sobel Z = 1.96, p < .05). This study suggests the benefit of appropriate levels of physical activity to promote both psychological health and ART adherence in people living with HIV.

Psychological effects of outdoor activity in type 2 diabetes: a review

Previous research has shown individuals living with type 2 diabetes are more likely to experience depression, anxiety and reduced quality of life (QoL) in comparison to those without the disease. Physical activity has been highlighted as an important factor in improving physiological and psychological parameters in this population. Previous systematic reviews have found mixed results regarding the effects of exercise on psychological problems. Green exercise is an emerging research area with mounting evidence demonstrating positive effects on mental health. Objectives of the current review investigated whether conducting physical activity in outdoor environments had any effect on psychological problems in individuals with type 2 diabetes. Methods such as PubMed, Medline, PsycINFO, Scopus, Cochrane library, CINAHL, SPORTDiscus and Google Scholar databases were searched. The databases were searched for articles which used an outdoor exercise intervention and investigated psychological problems in individuals with type 2 diabetes. Results from the 1467 retrieved articles, 4 studies were included in the systematic review, consisting of 231 participants. All four studies investigated QoL, one study looked at depression and one investigated general wellbeing. Mixed results were found regarding QoL, no significant effect was found for depression. However, general wellbeing was improved. Due to the limited number of studies eligible for inclusion and the heterogeneity of outcome measures, it was difficult to draw firm conclusions. This systematic review acts as a starting point for future investigations into the use of green exercise in improving the mental health of individuals living with type 2 diabetes. Registration: PROSPERO: CRD42018088212.

Hypothalamic Crh/Avp, Plasmatic Glucose and Lactate Remain Unchanged During Habituation to Forced Exercise

It has been demonstrated that physical activity contributes to a healthier life. However, there is a knowledge gap regarding the neural mechanisms producing these effects. One of the keystones to deal with this problem is to use training programs with equal loads of physical activity. However, irregular motor and stress responses have been found in murine exercise models. Habituation to forced exercise facilitates a complete response to a training program in all rodents, reaching the same load of physical activity among animals. Here, it was evaluated if glucose and lactate - which are stress biomarkers - are increased during the habituation to exercise. Sprague-Dawley rats received an 8-days habituation protocol with progressive increments of time and speed of running. Then, experimental and control (non-habituated) rats were subjected to an incremental test. Blood samples were obtained to determine plasmatic glucose and lactate levels before, immediately after and 30 min after each session of training. Crh and Avp mRNA expression was determined by two-step qPCR. Our results revealed that glucose and lactate levels are not increased during the habituation period and tend to decrease toward the end of the protocol. Also, Crh and Avp were not chronically activated by the habituation program. Lactate and glucose, determined after the incremental test, were higher in control rats without previous contact with the wheel, compared with habituated and wheel control rats. These results suggest that the implementation of an adaptive phase prior to forced exercise programs might avoid non-specific stress responses.

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.

Psychosocial Functioning After One Year of Interdisciplinary Pediatric Weight Management

Youth with obesity are more likely than normal-weight peers to experience psychosocial problems. Empirically-based recommendations for addressing pediatric obesity include intensive interdisciplinary weight management comprising medical, behavioral health, nutrition, and exercise components. The present study examined changes in psychosocial functioning associated with frequency of participation in an interdisciplinary pediatric weight management program. Participants were 86 patients (55.8% females; median age = 11.5 years; 67.4% Non-Hispanic Black; median BMI percentile = 99.5) enrolled in an interdisciplinary pediatric weight management program for at least one year. Psychosocial functioning was measured with the Pediatric Symptom Checklist (PSC-17), a caregiver-completed mental health screen that assesses internalizing, externalizing, and attention difficulties as well as global functioning. The PSC-17 was completed at the initial clinic visit (baseline) and repeated one-year later (annual). The Wilcoxon Signed Rank test indicated that annual PSC-17 scores were significantly lower than baseline scores across all domains. Spearman correlation coefficients revealed no significant association between total number of clinic visits and PSC-17 global or subscale scores. However, the number of visits for exercise-only sessions was significantly correlated with caregiver-reported improvement in internalizing behaviors. Findings suggest that participation in interdisciplinary pediatric weight management may improve psychosocial functioning in youth with obesity and that attending supervised exercise sessions may be especially beneficial for improving internalizing behavior symptoms.

Emotional eating and obesity in adults: the role of depression, sleep and genes

Stress and other negative emotions, such as depression and anxiety, can lead to both decreased and increased food intake. The term 'emotional eating' has been widely used to refer to the latter response: a tendency to eat in response to negative emotions with the chosen foods being primarily energy-dense and palatable ones. Emotional eating can be caused by various mechanisms, such as using eating to cope with negative emotions or confusing internal states of hunger and satiety with physiological changes related to emotions. An increasing number of prospective studies have shown that emotional eating predicts subsequent weight gain in adults. This review discusses particularly three lines of research on emotional eating and obesity in adults. First, studies implying that emotional eating may be one behavioural mechanism linking depression and development of obesity. Secondly, studies highlighting the relevance of night sleep duration by showing that adults with a combination of shorter sleep and higher emotional eating may be especially vulnerable to weight gain. Thirdly, an emerging literature suggesting that genes may influence body weight partly through emotional eating and other eating behaviour dimensions. The review concludes by discussing what kind of implications these three avenues of research offer for obesity prevention and treatment interventions.

Do Non-Responders to Exercise Exist-and If So, What Should We Do About Them?

It is well established that exercise is an important component in the maintenance of good health, and yet recent studies have demonstrated that a sub-section of individuals experience no significant improvements following an exercise training intervention. Such individuals are commonly termed “non-responders”. However, recently a number of researchers have taken a skeptical view as to whether exercise non-response either exists, or is clinically relevant. Here, we explore the research underpinning exercise response, to determine whether non-response to exercise actually exists. We discuss the impact of measurement error and assessment type on the identification of “non-responders”, and whether such non-response is global- or modality-specific. Additionally, we discuss whether, if non-response to an exercise intervention is meaningful and relevant, certain additional interventions—in the form of increasing exercise intensity, volume, or duration—could be made in order to enhance training adaptations. Consequently, based on our interpretations of the available evidence, we suggest that it is unlikely that global non-responders to exercise exist. Furthermore, we suggest this realization effectively counters the perception that some individuals will not positively respond to exercise, and that in turn, this insight serves to encourage health professionals to create more nuanced, efficacious, and individually-focused exercise prescriptions designed to circumvent and overcome apparent non-responsiveness. Adopting a more individually-adaptive approach to exercise prescription could, subsequently, prove a powerful tool in promoting population health.

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.