The association between depressive symptoms and physical status including physical activity, aerobic and muscular fitness tests in children

Physical Fitness and Risk of Mental Disorders in Children and Adolescents

Importance

With the rising prevalence of mental disorders among children and adolescents, identifying modifiable associations is critical.

Objective

To examine the association between physical fitness and mental disorder risks.

Design, Setting, and Participants

This nationwide cohort study used data from the Taiwan National Student Fitness Tests and National Health Insurance Research Databases from January 1, 2009 to December 31, 2019. Participants were divided into 2 cohorts targeting anxiety and depression (1 996 633 participants) and attention-deficit/hyperactivity disorder (ADHD; 1 920 596 participants). Participants were aged 10 to 11 years at study entry and followed up for at least 3 years, had a nearly equal gender distribution, and an average follow-up of 6 years. Data were analyzed from October 2022 to February 2024.

Exposures

Assessments of physical fitness included cardiorespiratory fitness (CF), muscular endurance (ME), muscular power (MP), and flexibility, measured through an 800-m run time, bent-leg curl-ups, standing broad jump, and sit-and-reach test, respectively.

Main Outcomes and Measures

Kaplan-Meier method calculated the cumulative incidence of anxiety, depression, and ADHD across fitness quartiles. Additionally, multivariable Cox proportional hazards models were used that included all 4 fitness components and explored sex and income as modifiers.

Results

The anxiety and depression cohort had 1 996 633 participants (1 035 411 participants were male [51.9%], and the median [IQR] age was 10.6 [10.3-11.0] years), while the ADHD cohort had 1 920 596 (975 568 participants were male [51.9%], and the median [IQR] age was 10.6 [10.3-11.0] years). Cumulative incidence of mental disorders was lower among participants in better-performing fitness quartiles, suggesting a dose-dependent association. Gender-specific analyses, controlling for confounders, revealed that improved CF, indicated by a 30-second decrease in run times, was associated with reduced risks of anxiety, depression, and ADHD in female participants, and lower risks of anxiety and ADHD in male participants (adjusted hazard ratio [aHR] for ADHD risk for female participants, 0.92; 95% CI, 0.90-0.94; P < .001; for male participants, 0.93; 95% CI, 0.92-0.94; P < .001). Enhanced ME, marked by an increase of 5 curl-ups per minute, was associated with decreased risks of depression and ADHD in female participants, and lower anxiety and ADHD risks in male participants (aHR for ADHD risk for female participants, 0.94; 95% CI, 0.92-0.97; P < .001; for male participants, 0.96; 95% CI, 0.95-0.97; P < .001). Improved MP, reflected by a 20-cm increase in jump distance, was associated with reduced risks of anxiety and ADHD in female participants and reduced anxiety, depression, and ADHD in male participants (aHR for ADHD risk for female participants, 0.95; 95% CI, 0.91-1.00; P = .04; for male participants, 0.96; 95% CI, 0.94-0.99; P = .001).

Conclusions and Relevance

This study highlights the potential protective role of cardiorespiratory fitness, muscular endurance, and muscular power in preventing the onset of mental disorders. It warrants further investigation of the effectiveness of physical fitness programs as a preventive measure for mental disorders among children and adolescents.

Physical Fitness for Depression in Adolescents and Adults: A Meta-Analysis

Background

Depression has been recognized as one of the most significant factors affecting mental health status. For this reason, several efforts to prevent and reduce depression in all ages have been made in various domains to identify the relevant factors as well as the causes of depression. The objective of this meta-analysis was to examine the effect size between physical fitness and depression in adolescents and adults.

Methods

A systematic search for meta-analysis (2009-2020) was performed using PubMed, Scopus, Web of Science, and RISS, with key terms such as depression, depressive illness, and physical fitness or fitness. Overall, 19 out of 448 articles were included in the meta-analysis with strict inclusion criteria.

Results

The effect size is a medium between physical fitness and depression in adolescents and adults. Two fitness factors, namely cardiovascular endurance and muscle strength, are more relevant for alleviating depression in adolescents and adults, whereas agility was not related to depression. In particular, the cardiovascular fitness factor has an impact on almost all ages; however, muscular strength has less impact on depression in young adolescents, but has a great impact on older adults' depression.

Conclusion

The effect size in this study is a medium between physical fitness and depression in adolescents and adults. Thus, more longitudinal and clinical studies with larger sample sizes are needed to clarify the relationship between physical fitness and depression.

The Effect of Physical Exercise on Depression in College Students: The Chain Mediating Role of Self-Concept and Social Support

Objective

This study introduced self-concept and social support as research variables to establish a research mechanism, in order to encourage college students to participate in sports better, relieve or overcome depression.

Methods

The survey was conducted among 1,200 college students in Jiangxi, China. Serial mediation models were used to examine whether self-concept and social support mediated in the effect of physical exercise on depression.

Results

Physical exercise significantly negatively predicted college depression. Moreover, Self-concept and social support mediate the relationship between physical exercise and depression in college students.

Conclusion

This study reveals how physical exercise affects college students' depression and its mechanism, and the results have certain enlightenment significance for maintaining and promoting college students' physical and mental health.

Healthier Minds in Fitter Bodies: A Systematic Review and Meta-Analysis of the Association between Physical Fitness and Mental Health in Youth

BACKGROUND

Physical fitness is an important marker of current and future health status, yet the association between physical fitness and indicators of mental health in youth has not been systematically reviewed and meta-analyzed.

OBJECTIVE

The aim of this work was to systematically review and meta-analyze the association between physical fitness components (i.e. cardiorespiratory fitness, muscular fitness, speed-agility, flexibility and fitness composite) and mental health indicators (i.e. psychological well-being and psychological ill-being) in preschoolers, children and adolescents.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Systematic searches were conducted in PubMed, Web of Science and Scopus from database inception to May 2020.

ELIGIBILITY CRITERIA

Studies (cross-sectional, longitudinal and intervention designs) were included if they measured at least one physical fitness component and one mental health indicator in healthy youth (2-18 years).

RESULTS

A total of 58 unique studies (52 cross-sectional, 4 longitudinal and 4 intervention studies) met all eligibility criteria and were included. There was a significant positive overall association between physical fitness and mental health in children and adolescents (pooled r = 0.206, p < 0.001). We found suggestive evidence of moderation by age group, fitness components and socioeconomic status (all p < 0.08). No relevant studies focusing on preschoolers were identified. Evidence based on longitudinal and intervention studies was limited.

CONCLUSION

We observed a small to medium sized positive association between physical fitness and overall mental health in youth. However, as the majority of studies were cross-sectional, additional longitudinal and intervention studies are needed to provide evidence of causation.

TRIAL REGISTRATION

PROSPERO registration number CRD42017080005.

Association between cardiorespiratory fitness and depressive symptoms in children and adolescents: A systematic review and meta-analysis

Background Higher cardiorespiratory fitness (CRF) is associated with lower depressive symptoms in adults. However, no systematic review with meta-analysis assessed the cross-sectional associations between CRF and depressive symptoms in children and adolescents. Therefore, this meta-analysis assessed the relationship between CRF and depressive symptom in these populations. Methods Cross-sectional data evaluating the correlation between CRF and depression were searched, from database inception through 21/05/2020, on PubMed, PsycINFO, Web of Science, and SPORTDiscus. Age, sex, CRF and depression assessments, and correlations were extracted. A random-effects meta-analysis was conducted, and the potential sources of heterogeneity were also explored through meta-regression analysis. Results Across 14 effects of 11 unique studies, including a total of 7,095 participants (median age=12.49) with nearly equal sex distribution (median=53% females), it was found that higher CRF was associated with lower depressive symptoms in children and adolescents (r =-0.174, 95%CI -0.221 to -0.126, p<0.001, I²=75.09, Q value=52.19). No moderators were identified. Conclusion Available evidence supports the notion that higher CRF is inversely associated with depressive symptoms in children and adolescents. Physical activity and exercise interventions targeting improving CRF should be promoted for these populations. Further studies, including clinical populations, should be conducted to assess objective measures of aerobic fitness and body composition, while controlling for puberty status, to better characterize this association.

Influence of a Physical Exercise Program in the Anxiety and Depression in Children with Obesity

(1) Background: The high prevalence of childhood obesity and its multicausal etiology make it necessary to approach it through different strategies, whose objective is to promote the physical, mental, and social well-being of children. Regular physical activity, in addition to having positive effects on the physical environment of those who practice it, influences positively in psychological aspects such as anxiety and depression, which are very frequent in children with obesity and overweight. (2) Objective: To analyze the changes produced by a program of physical exercise based on anthropometric indicators and levels of anxiety and depression in a population of Mexican children with obesity. (3) Methods: A longitudinal study with experimental group (EG) and control group (CG). The analysis population consisted of 105 children with a body mass index (BMI) for their gender and age group above the 95th percentile, of which 60 were girls and 45 were boys, with a mean age of 10.02 years (SD ± 0.79). By randomizing the participants, 54 were part of the EG and 51 of the, CG The EG participated in a physical exercise program, distributed in two weekly sessions, each lasting 50 minutes, for 20 consecutive weeks. The CG group continued its usual activities during the intervention period. An inferential analysis was performed between the socio-demographic, anthropometric and psychological variables. (4) Results: The implementation of a physical exercise program in children with obesity favors the appearance of positive thoughts, with improvements in their emotional well-being, self-perception and self-concept; although it does not produce significant changes in weight, height, Z-Score, level of anxiety or depressive thoughts. (5) Discussion: Regular physical exercise practice has positive effects on mental health, although new studies are required to analyze specifically its influence on anxiety and depression in children with obesity.

Is obesity associated with impaired reaction time in youth?

BACKGROUND AND PURPOSE

Recent research demonstrates a significant relationship between weight status and impaired reaction time in young, adult, and elderly individuals. However, most such studies were performed on small samples, used only body mass index as the body obesity index, used simple reaction time, and oftentimes did not consider some potential confounders such as age, socioeconomic status, or physical activity in their studies. The present study explored the relationship between various reaction time tasks and various obesity indices in a sample of youth.

METHODS

Two hundred and thirty-four young males (19-24 years) underwent standard anthropometry, various information processing tasks (e.g., clinical reaction time, simple audio and visual reaction time, and choice reaction time), as well as an inhibitory control task (congruent and incongruent Simon reaction time).

RESULTS

Results revealed no significant relationship between any of the information processing tests and body mass index, nor for fat percentage, waist circumference, and waist-to-height ratio after adjustment for potential confounders. A weak positive association was observed only between congruent Simon reaction time (but not incongruent Simon reaction time) and waist circumference in participants (t value = 0.199; Std error = 0.0014; p = 0.047; Cohen's f² = 0.09).

CONCLUSION

Inhibitory control, but not information processing speed, was associated only with waist circumference in apparently healthy young men.

LEVEL OF EVIDENCE

Level I, experimental study.

Recurrent depression in childhood and adolescence and low childhood socioeconomic status predict low cardiorespiratory fitness in early adulthood

BACKGROUND

Cardiorespiratory fitness (CRF) strongly influences health, but very little is known about the childhood determinants of adult CRF. Our longitudinal study investigated whether childhood psychopathology and socioeconomic status (SES) were related to adult CRF in 1647 Finnish male military conscripts.

METHODS

Childhood psychopathology was assessed at the age of eight using the Rutter and Children's Depression Inventory questionnaires. Parental education and family structure were used to assess childhood SES. In late adolescence, depressive symptoms were assessed with the Beck Depression Inventory and smoking with a questionnaire. CRF in early adulthood was examined with the Cooper's 12-minute run test.

RESULTS

General linear models showed that low parental education (p=0.001), depressive symptoms in childhood (p=0.035) and late adolescence, smoking, underweight, and overweight/obesity (all p<0.001) independently predicted lower CRF. The interaction between depressive symptoms in childhood and adolescence was significant (p=0.003). In adolescents with depressive symptoms, childhood depressive symptoms (p=0.001) and overweight/obesity (p<0.001) predicted lower CRF. In adolescents without depressive symptoms, conduct problems in childhood predicted lower CRF in the initial models, but the effect disappeared after taking into account smoking and body mass index. Mediational analysis confirmed these results.

LIMITATIONS

We lacked data on physical activity and only studied males at three time-points.

CONCLUSIONS

Recurrent depression in childhood and adolescence and low SES in childhood predict lower adult CRF. Conduct problems in childhood predict lower CRF, but the effect is mediated by overweight/obesity and smoking. Psychiatric treatment for children and adolescents should promote physical activity, particularly for children with low SES.

Association between physical fitness and cognitive performance in 19-24 year old males

The present study aimed to explore the association between physical fitness (PF) and cognitive performance in a sample of 19-24 year old males. Two hundred and eleven young males (20.2±1.5 years) participated in the study. Cognitive functioning tasks including information processing speed and inhibitory control were measured in addition to PF and motor fitness components such as aerobic fitness, static strength, explosive strength, agility and speed. Regression analysis showed that after adjustment for potential confounders (e.g. age, socioeconomic status, adiposity and physical activity), aerobic fitness (represented by shorter time in the one-mile run) was positively associated with composite inhibitory control scores (standardized β=0.17; p=0.04) and negatively associated with ∆ Simon (standardized β= -0.21; p=0.04). Explosive strength was negatively associated with composite information processing scores (standardized β= -0.24; P=0.01), and composite inhibitory control scores (standardized β= -0.22; p=0.02). Speed of movement, agility and static strength were not associated with any of the cognitive tests. In conclusion, aerobic fitness and explosive strength but not speed, agility or static strength might be indicators of underlying cognitive functioning tasks in 19-24 year old males.

Central or overall obesity: which one is a better predictor of depressive symptoms in children, adolescents, and youths?

BACKGROUND AND PURPOSE

Despite the strong effect of central obesity on individuals' physical health outcomes, there is little evidence underlying the relationship between central obesity and mental disorders such as depression, especially in children, adolescents, and youths of the developing countries. This study explores the relationship between depressive symptoms (DS) with central and overall obesity in a sample of Iranian children, adolescents, and youths.

METHODS

One thousand and fifty-two male participants ranging from 7 to 24 years old underwent standard anthropometry, and filled the DS questionnaire.

RESULTS

Having controlled the potential confounders (e.g., age, socioeconomic status, pubertal maturation status, and physical activity), we found waist circumference (WC) significantly related to DS in the children (standardized β = 0.14; P < 0.05) and adolescents (standardized β = 0.13; P < 0.05). No significant relationship was observed between WC and DS in the youths (standardized β = 0.09; P = 0.22). In addition, no significant relationship was observed between DS and the percentage of fat in the sampled children (standardized β = 0.085; P = 0.13), adolescents (standardized β = 0.10; P = 0.10), and youths (standardized β = -0.02; P = 0.75).

CONCLUSION

Central obesity (but not overall obesity) was a significant predictor of DS in the children and adolescents (7-18 years). However, DS in the youths (19-24 years) were not significantly associated with both the central and overall body obesity indices.

Sex and maturity status affected the validity of a submaximal cycle test in adolescents

AIM

This study assessed the validity and reliability of the Ekblom-Bak (EB) submaximal cycle test in adolescents and identified any sex- or maturity-related factors for prediction errors.

METHODS

We recruited 50 healthy subjects through a public announcement in Stockholm, Sweden, in 2016. The 27 boys and 23 girls were aged 10-15 years and in Tanner stages I-IV. They performed an EB test and incremental treadmill running test for direct measurement of maximal oxygen uptake (VO₂ max).

RESULTS

The estimation error of VO₂ max was 0.09 L/min. The correlation (r) was 0.86, and the standard error of the estimate (SEE) was 0.29 L/min. The largest overestimation was seen in prepubertal boys (0.49 L/min). The best precision of the EB test was achieved when boys in Tanner stages I and II were re-calculated using the prediction equation developed for adult women. This yielded a mean difference of -0.05 L/min, r = 0.92 and SEE 0.23 L/min, in the entire sample. The prediction error was lowered in boys, but not girls, with increasing pubertal maturity.

CONCLUSION

The EB test was reasonably valid in adolescents, seemed to be related to sex and maturity status, and our findings support its use.

Simple reaction time and obesity in children: whether there is a relationship?

OBJECTIVE

Reaction time (RT) testing is one of the oldest diagnostic methods used in modern psychology, and is known as simple and sensitive cognitive test. It has been recently reported that RT is related to obesity in young, adult and elderly individuals. However, most of the studies included small sample of participants, used just body mass index (BMI) as body obesity index, and did not consider some potential confounders such as age, socioeconomic status and physical activity in their studies. Furthermore, there is little and contradictory results for children. Therefore, the present study aimed to examine the relationship between RT and weight status in a sample of children.

METHODS

Three hundred and fifty four 9-12 year old schoolboys underwent standard anthropometry, and various simple RT tests.

RESULTS

After controlling for potential confounders no significant relationship was observed between audio-RT (RTA) and clinical RT (RTclin) with BMI, %fat, waist circumference (WC) and waist to height ratio (WHtR) (P > 0.05). But, significant relationship (β = 0.18; P = 0.02) was observed between visual-RT (RTV) and %fat (but not BMI, WC and WHtR).

CONCLUSIONS

Among the various simple RT tasks and central and total body obesity indices, just significant relationship was observed between %fat and RTV in the schoolboys. According to the results, it is concluded that RT impairment due to obesity may less be observed, or may not be observed for some types of RT tasks and obesity indices during childhood.