Physical Activity and Anxiety: A Systematic Review and Meta-analysis of Prospective Cohort Studies

Diurnal variation in anxiety and activity is influenced by chronotype and probable anxiety-related disorder status

Anxiety symptoms vary moment-to-moment within a day. One factor that may influence these variations is chronotype. Evening chronotypes prefer to engage in activities (e.g., sleep, physical and social activity) later in the day, and evening chronotype is implicated in psychopathology, including anxiety-related disorders. However, it is unknown whether chronotype influences diurnal variation in anxiety symptoms and whether these effects are amplified in individuals with a probable anxiety-related disorder. We examined the diurnal variation in anxiety symptoms and daily activities in morning and evening chronotypes with and without probable generalized anxiety disorder (GAD) or obsessive-compulsive disorder (OCD) in a community sample of adults (N = 410). Evening chronotypes reported higher anxiety symptoms, particularly in the evening hours, and lower engagement in daily activities, predominantly in the morning hours. Evening chronotypes with probable GAD or OCD reported worse anxiety symptoms in the evening. Our findings indicate that anxiety symptoms and engagement in daily activities fluctuate considerably across the day, and these patterns differ depending on chronotype. Evening chronotypes have more anxiety symptoms in the evening, despite preferring this time of day. Personalized treatment approaches that consider chronotype and target certain times of day may be efficient in alleviating peaks in anxiety symptoms.

Evaluation of the association of physical activity levels with self-perceived health, depression, and anxiety in Spanish individuals with high cholesterol levels: a retrospective cross-sectional study

Background

Hypercholesterolemia is the most common form of dyslipidaemia in the world leading to negative health effects, both physical and mental. Physical activity (PA) can reduce total cholesterol and has positive effects on mental health. This retrospective cross-sectional study analyses the relationships between physical activity level (PAL), self-perceived health (SPH) and mental health.

Methods

This study was based on data from the Spanish National Health Survey 2017 (SNHS 2017), with 3,176 Spanish adults with high cholesterol as participants. Non-parametric tests were used as the data did not follow normality.

Results

Dependent relationships were found between PAL and SPH, depression and anxiety. Women had higher depression and anxiety prevalences than men, while men were more likely to report being very active, although the proportion of walkers was higher in women. The physically inactive population presented higher negative SPH, depression and anxiety proportions and psychological distress than physically active people.

Conclusion

The physically inactive people had a higher risk of negative SPH, depression and anxiety. Regular PA may improve SPH and mental health in people with high cholesterol, but more studies are needed to establish causal relationships, mechanisms, and optimal doses.

Associations between device-measured and self-reported physical activity and common mental disorders: Findings from a large-scale prospective cohort study

OBJECTIVES

To investigate the associations between device-measured and self-reported physical activity (PA) and incident common mental disorders in the general population.

DESIGN AND SETTING

Large-scale prospective cohort study.

PARTICIPANTS

Using the UK Biobank data, a validated PA questionnaire was used to estimate self-reported weekly PA in 365 656 participants between 2006 and 2010 while 91 800 participants wore wrist-worn accelerometers for 7 days in 2013-2015 to derive objectively measured PA. All the participants were followed up until 2021.

MAIN OUTCOME MEASURES

Incidences of depression and anxiety were ascertained from hospital inpatient records. Cox proportional hazards models and restricted cubic splines were used to assess the associations between subjectively and objectively measured PA and common mental disorders.

RESULTS

During a median follow-up of 12.6 years, 16 589 cases of depression, 13 905 cases of anxiety and 5408 cases of comorbid depression and anxiety were documented in the questionnaire-based cohort. We found J-shaped associations of self-reported PA with incident risk of depression and anxiety, irrespective of PA intensities. The lowest risk for depression occurred at 550, 390, 180 and 560 min/week of light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA) and moderate-to-vigorous PA (MVPA), respectively. During a median follow-up of 6.9 years, a total of 2258 cases of depression, 2166 cases of anxiety and 729 cases of comorbid depression and anxiety were documented in the accelerometer-based cohort. We found L-shaped associations of device-measured MPA and VPA with incident depression and anxiety. MPA was adversely associated with incident depression and anxiety until 660 min/week, after which the associations plateaued. The point of inflection for VPA occurred at 50 min/week, beyond which there was a diminished but continued reduction in the risks of depression and anxiety.

CONCLUSION

Different patterns of associations between self-reported and device-measured PA and mental health were observed. Future PA guidelines should fully recognise this inconsistency and increasingly employ objectively measured PA standards.

A study on acute expectation effects on affective state and intention after a brief full-body workout in a student sample

Brief exercise bouts can have positive effects on the affective state, which in turn could affect the intention for future exercise. Such benefits may be enhanced by manipulating expectations. The aim of this study was to examine whether the affective state after physical activity or the intention for future exercise can be influenced by manipulating expectations. Furthermore, the relationship between affect and intention was investigated. In an online experiment, 121 persons completed either a 10-minute workout (PA), a workout after manipulation of expectations (PA + EM), or a control intervention (CG) after randomized group allocation. Data on affective state, expectations, and intention were collected before and after the intervention using questionnaires. After intervention, PA groups showed significantly more positive values than CG in several affective parameters, in other affective parameters, only PA + EM differed from CG. Affect was positively associated with intention alongside outcome expectations. No difference was found in intention. Although no significant effects of expectation manipulation on affective state or intention were found, latent effects cannot be ruled out. Further exploration of the importance of word choice in describing physical activity in the context of interventions to increase physical activity is necessary. Here, affect should be considered.

Movement Behaviors and Mental Health of Catholic Priests in the Eastern United States

The purpose of this observational study was to examine (a) the proportion of Catholic priests in the United States that have anxiety/depression and meet the Canadian 24-Hour of Movement Guidelines, and (b) the association of meeting these guidelines with the likelihood of anxiety and depression. A sample of (arch)diocesan priests (n = 335) completed demographic and behavior survey, International Physical Activity Questionnaire (IPAQ-SF), and Hospital Anxiety and Depression Scale (HADS). Results indicated that 21.1% of priests surveyed met all three movement guidelines (physical activity, sleep, and screentime) and 7.8% met none. Priests who reported excessive recreational screentime (≥ 3 h/day) were more likely to have anxiety (OR = 3.17) and depression (OR = 2.91), and who were physically inactive (< 150 min/week) were more likely to have depression (OR = 8.89). Data from this study addresses a gap in the literature regarding Catholic priests, movement behavior, and mental wellbeing.

Valuing the health benefits of nature-based recreational physical activity in England

Physical activity (PA) reduces the risk of several non-communicable diseases (NCDs). Natural environments support recreational PA. Using data including a representative cross-sectional survey of the English population, we estimated the annual value of nature-based PA conducted in England in 2019 in terms of avoided healthcare and societal costs of disease. Population-representative data from the Monitor of Engagement with the Natural Environment (MENE) survey (n = 47,580; representing 44,386,756) were used to estimate the weekly volume of nature-based recreational PA by adults in England in 2019. We used epidemiological dose-response data to calculate incident cases of six NCDs (ischaemic heart disease (IHD), ischaemic stroke (IS), type 2 diabetes (T2D), colon cancer (CC), breast cancer (BC) and major depressive disorder (MDD)) prevented through nature-based PA, and estimated associated savings using published costs of healthcare, informal care and productivity losses. We investigated additional savings resulting from hypothetical increases in: (a) visitor PA and (b) visitor numbers. In 2019, 22million adults > 16 years of age in England visited natural environments at least weekly. At reported volumes of nature-based PA, we estimated that 550 cases of IHD, 168 cases of IS, 1,410 cases of T2D, 41 cases of CC, 37 cases of BC and 10,552 cases of MDD were prevented, creating annual savings of £108.7million (95 % uncertainty interval: £70.3million; £150.3million). Nature-based recreational PA in England results in reduced burden of disease and considerable annual savings through prevention of priority NCDs. Strategies that increase nature-based PA could lead to further reductions in the societal burden of NCDs.

Physical activity and prevention of mental health complications: An umbrella review

The potential of physical activity in preventing mental health issues has garnered interest among health professionals. We conducted a systematic umbrella review of evidence supporting the relationship between physical activity and the prevention of mental health complications. Our findings revealed a significant association between higher physical activity levels and reduced risk of depression (OR = 0.77, 95% CI 0.72 - 0.82). This association was consistent across various age groups, sex, and geographical regions. Interestingly, low and moderate-intensity physical activity showed the most significant protective effects against depression (low-intensity: OR = 0.81, 95% CI: 0.75-0.56; moderate-intensity: OR = 0.79, 95% CI: 0.72-0.87). Our analysis also showed significant associations between higher physical activity levels and prevention of anxiety disorders (OR = 0.71, 95% CI: 0.61-0.82). However, the evidence regarding the association between physical activity and psychosis/schizophrenia risk was less clear. These findings underscore the physical activity's potential as a preventative measure against mental health complications, highlighting the importance of promoting physical activity in mental health interventions.

The effectiveness of the TRACE online nutrition intervention in improving dietary intake, sleep quality and physical activity levels for Australian adults with food addiction: a randomised controlled trial

BACKGROUND

Few interventions for food addiction (FA) report on dietary intake variables. The present study comprised a three-arm randomised controlled trial in adults with symptoms of FA. The aim was to evaluate dietary intake, sleep and physical activity resulting from a dietitian-led telehealth intervention at 3 months.

METHODS

Adults with ≥3 symptoms of FA and a body mass index > 18.5 kg/m2 were recruited. Dietary intake including energy, nutrients and diet quality were assessed by a validated food frequency questionnaire in addition to sleep quality and physical activity (total min) and compared between groups and over time. Personalised dietary goals set by participants were examined to determine whether improvements in percent energy from core and non-core foods were reported.

RESULTS

The active intervention group was superior compared to the passive intervention and control groups for improvements in percent energy from core (6.4%/day [95% confidence interval (CI) -0.0 to 12.9], p = 0.049), non-core foods (-6.4%/day [95% CI -12.9 to 0.0], p = 0.049), sweetened drinks (-1.7%/day [95% CI -2.9 to -0.4], p = 0.013), takeaway foods (-2.3%/day [95% CI -4.5 to -0.1], p = 0.045) and sodium (-478 mg/day [95% CI -765 to -191 mg], p = 0.001).

CONCLUSIONS

A dietitian-led telehealth intervention for Australian adults with FA found significant improvements in dietary intake variables. Setting personalised goals around nutrition and eating behaviours was beneficial for lifestyle change.

Development and validation of the core life activities scale

Life activities profoundly influence well-being, mental health, and quality of life. The COVID-19 pandemic has heightened the importance of monitoring these activities for psychological and emotional health. However, existing measurement tools are limited, particularly for assessing psychological health. To address this gap, we developed and validated the Core Life Activities (CORE) scale, comprising five key factors (sleep, exercise, learning, diet, and social relationships) identified in neuroscience, cognitive psychology, and gerontology. In Study 1 (n = 1,137), exploratory and confirmatory factor analyses supported a single-factor structure with good model fit (χ2 = 6.377, df = 3, TLI = 0.992, CFI = 0.998, RMSEA = 0.031), demonstrating robust internal consistency (Cronbach's alpha = 0.776) and test-retest reliability (intraclass correlation coefficient = 0.522, p < 0.001). The CORE exhibited significant convergent validity with mental health screening tools for depressive and anxiety disorders and suicidality. Study 2 (n = 684) confirmed a significant correlation between CORE and the World Health Organisation Quality of Life Brief Version, complementing the convergent validity found in Study 1. In addition, discriminant validity was confirmed by a non-significant correlation with the COVID-19 Preventive Behavior Scale. The findings establish the CORE as a reliable and valid tool, offering a simple yet comprehensive measure for assessing core life activities with potential applications in diverse environments.

Physical activity, low-grade inflammation, and psychological responses to the COVID-19 pandemic among older adults in England

Mental health responses to the COVID-19 pandemic have been widely studied, but less is known about the potentially protective role of physical activity (PA) and the impact of low-grade inflammation. Using a sample of older adults from England, this study tested (1) if pre-pandemic PA and its changes during the pandemic were associated with mental health responses; (2) if older adults with low-grade inflammation experienced greater increases in depression and anxiety, compared to pre-pandemic levels; (3) if PA attenuated the association between inflammation and depression/anxiety. The study used data from the English Longitudinal Study of Ageing, a cohort study following a national sample aged 50+. Information on mental health and PA were collected before the pandemic (2016/17 and 2018/19) and during November and December 2020. Inflammation was ascertained using pre-pandemic C-reactive protein (CRP). Analyses were adjusted for sociodemographic and health-related factors and pre-pandemic mental health. Increasing PA from before to during the pandemic was linked to reduced odds of depression (OR = 0.955, 95%CI [0.937, 0.974]) and anxiety (OR = 0.954, 95%CI [0.927; 0.982]). Higher pre-pandemic PA was associated with reduced odds of depression (OR = 0.964, 95%CI [0.948, 0.981]) and anxiety (OR = 0.976, 95%CI [0.953, 1.000]), whereas elevated CRP was associated with 1.343 times higher odds of depression (95%CI [1.100, 1.641]). PA did not attenuate the inflammation-depression association. The findings suggest that PA may contribute to psychological resilience among older adults, independently of inflammation. Further research is needed to explore the psychobiological pathways underlying this protective mechanism.

Associations of Anxiety, Insomnia, and Physical Activity during the COVID-19 Pandemic

PURPOSE

Anxiety, insomnia, and physical activity (PA) are interrelated, but the bi-directional relationships between these three variables are not well understood. Less is known of these relationships in settings of disrupted daily activities and acute stress. This study aimed to characterize and examine relationships between insomnia, anxiety, and PA throughout the first year of the COVID-19 pandemic, when many lifestyle behaviors were disrupted.

METHODS

Participants comprised a convenience sample of 204 adults (55.4% female; 43.85 ± 15.85 years old) who completed the Generalized Anxiety Disorder Questionnaire (GAD-7), Insomnia Severity Index (ISI), and the International Physical Activity Questionnaire (IPAQ) at three time points through the first year of the COVID-19 pandemic. A cross-lagged panel model was used to evaluate these variables' concurrent, autoregressive, and cross-lagged relationships across time. Follow-up dynamic panel modeling using maximum likelihood and structural equation modeling was employed.

RESULTS

Approximately 64% of participants reported their work/occupation as affected by the pandemic. At baseline, associations between anxiety and insomnia were observed (β-coefficient: 15.87; p < 0.001). Insomnia was a positive future predictor of anxiety (ISI time point 2: 7.9 ± 5.6 points; GAD-7 at time point 3: 4.1 ± 4.2 points; β-coefficient: 0.16; p < 0.01). No associations were observed between PA and anxiety or insomnia (all p > 0.05).

CONCLUSIONS

Insomnia and anxiety were interrelated, and effects were cross-lagged. These data can inform future work focused on improving anxiety in settings of acute stress and disruptions to daily life, such as changes in occupational structure and stability. Specifically, targeting sleep parameters may be of interest to elicit downstream positive health behaviors.

Returning to sport after injury: the influence of injury appraisals and post-traumatic stress symptoms on adolescent risk-taking intentions post-injury

OBJECTIVE

How youth think about injury risk can affect their decisions about whether to engage in behaviors that can lead to injury. Appraisals also influence the development of post-traumatic stress symptoms (PTSS), which occur in approximately 20% of children after a medically treated injury. The current study examined how the injury appraisals of youth are associated with the development of PTSS post-skateboarding injury, and if PTSS or perceived benefits of the sport are also associated with youths' intentions to return to the sport.

METHOD

One hundred three youth who had a medically treated skateboarding injury within the last year provided survey data on injury appraisals, PTSS, the benefits of skateboarding, and intentions to return to the sport.

RESULTS

A two-stage moderated statistical mediation path model was specified. In the first stage, there was a positive relationship between pain at injury and PTSS, which was attenuated by the moderator, perceived bad luck. PTSS fully mediated the association between perceived pain at the time of injury and intentions to return to skateboarding. In the second stage of the mediation model, the moderator perceived benefits of skateboarding, reversed the negative relationship between PTSS and intentions to return to skateboarding.

CONCLUSIONS

Skateboarders are a group at risk for injury that can lead to PTSS, and they also are likely to return to the sport despite PTSS. This research identifies factors that impact the decision to return to skateboarding after injury. Limitations of the study and implications for mental health support and injury prevention are provided.

Lessons and Untapped Potential of Smartphone-Based Physical Activity Interventions for Mental Health: Narrative Review

BACKGROUND

Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones, experts have quickly noted the utility of technology for the enhanced measurement of and intervention for physical activity. In addition to being more accessible than in-person approaches, technology-driven interventions may uniquely engage key mechanisms of behavior change such as self-awareness.

OBJECTIVE

This study aims to provide a narrative overview and specific recommendations for future research on smartphone-based physical activity interventions for psychological disorders or concerns.

METHODS

In this paper, we summarized early efforts to adapt and test smartphone-based or smartphone-supported physical activity interventions for mental health. The included articles described or reported smartphone-delivered or smartphone-supported interventions intended to increase physical activity or reduce sedentary behavior and included an emotional disorder, concern, or symptom as an outcome measure. We attempted to extract details regarding the intervention designs, trial designs, study populations, outcome measures, and inclusion of adaptations specifically for mental health. In taking a narrative lens, we drew attention to the type of work that has been done and used these exemplars to discuss key directions to build on.

RESULTS

To date, most studies have examined mental health outcomes as secondary or exploratory variables largely in the context of managing medical concerns (eg, cancer and diabetes). Few trials have recruited psychiatric populations or explicitly aimed to target psychiatric concerns. Consequently, although there are encouraging signals that smartphone-based physical activity interventions could be feasible, acceptable, and efficacious for individuals with mental illnesses, this remains an underexplored area.

CONCLUSIONS

Promising avenues for tailoring validated smartphone-based interventions include adding psychoeducation (eg, the relationship between depression, physical activity, and inactivity), offering psychosocial treatment in parallel (eg, cognitive restructuring), and adding personalized coaching. To conclude, we offer specific recommendations for future research, treatment development, and implementation in this area, which remains open and promising for flexible, highly scalable support.

The relationship between nighttime exercise and problematic smartphone use before sleep and associated health issues: a cross-sectional study

OBJECTIVE

Physical exercise has the potential to mitigate addictive behaviors and relevant health issues. However, the nighttime exercise has not been studied regarding this research topic. This study aims to explore the association between nocturnal physical exercise and problematic smartphone use before sleep, as well as related health issues.

METHODS

To explore the association between nighttime physical exercise and problematic smartphone use before sleep as well as related health issues, we conducted a cross-sectional survey among 1,334 college students. Their daily exercise behaviors (including timeframe, rationale, frequency, and duration), smartphone use before sleep, sleep quality, smartphone addiction, anxiety, and depression were measured by questionnaires. The associations were assessed using generalized linear models.

RESULTS

Our findings indicate that nearly 70% of participants chose to perform exercise at nighttime. Among these individuals who exercised at nighttime, the frequency and duration of nighttime exercise were significantly associated with decreased probabilities of smartphone use before sleep. Additionally, the frequency and duration of nighttime exercise were associated with lower levels of smartphone addiction and anxiety disorders.

CONCLUSION

Nighttime Exercise behaviors can effectively reduce sleep delays caused by problematic smartphone use before bedtime. These findings contribute to understanding the potential effects of nighttime exercise on problematic smartphone use and relevant health issues. Future research should employ more precise methodologies to examine these associations.

Sleep, physical activity and panic attacks: A two-year prospective cohort study using smartwatches, deep learning and an explainable artificial intelligence model

BACKGROUND

Sleep and physical activity suggestions for panic disorder (PD) are critical but less surveyed. This two-year prospective cohort study aims to predict panic attacks (PA), state anxiety (SA), trait anxiety (TA) and panic disorder severity (PDS) in the upcoming week.

METHODS

We enrolled 114 PD patients from one general hospital. Data were collected using the DSM-5, the MINI, clinical app questionnaires (BDI, BAI, PDSS-SR, STAI) and wearable devices recording daily sleep, physical activity and heart rate from 16 June 2020 to 10 June 2022. Our teams applied RNN, LSTM, GRU deep learning and SHAP explainable methods to analyse the data.

RESULTS

The 7-day prediction accuracies for PA, SA, TA, and PDS were 92.8 %, 83.6 %, 87.2 %, and 75.6 % from the LSTM model. Using the SHAP explainable model, higher initial BDI or BAI score and comorbidities with depressive disorder, generalized anxiety disorder or agoraphobia predict a higher chance of PA. However, PA decreased under the following conditions: daily average heart rate, 72-87 bpm; maximum heart rate, 100-145 bpm; resting heart rate, 55-60 bpm; daily climbing of more than nine floors; total sleep duration between 6 h 23 min and 10 h 50 min; deep sleep, >50 min; and awake duration, <53 min.

LIMITATIONS

Moderate sample size and self-report questionnaires were the limitations.

CONCLUSIONS

Deep learning predicts recurrent PA and various anxiety domains with 75.6-92.8 % accuracy. Recurrent PA decreases under adequate daily sleep and physical activity.

Physical activity dose for generalized anxiety disorder & worry: Results from the Irish longitudinal study on ageing

The lowest moderate-to-vigorous physical activity (MVPA) dose that conveys protection for Generalized Anxiety Disorder (GAD) and worry is unknown. This study quantified associations of weekly accumulated MVPA doses with GAD and worry across 10 years using data from The Irish Longitudinal Study on Ageing (TILDA). Continuous MVPA (metabolic equivalent of task [MET] minutes per week [MET.min.week-1]; e.g., moderate-intensity brisk walking = 4METs), three-dose and, more precise, five-dose MVPA categories were examined. Worry symptoms and GAD status were measured using the Penn State Worry Questionnaire-Abbreviated and the Composite International Diagnostic Interview. Multivariable negative random effect binomial regression and logistic models adjusted for relevant covariates quantified associations across time. Among the 7,650 participants, compared to no MVPA (0 MET.min.week-1), 18 % (OR: 0.82; 95 %CI: [0.69-0.98]), 22 % (OR: 0.78; [ 0.64-0.95]) and 31 % (OR: 0.69; [0.59-0.79]) lower odds of GAD were found for the doses of 1-<600, 600-<1,200 and ≥2,400 MET.min.week-1 respectively. Post-hoc analysis demonstrated 47 % lower odds (OR: 0.53; (0.36-0.78) of GAD for 1-<200 MET.min.week1 compared to inactivity. Compared to no activity, engaging in even minimal physical activity equivalent of 10 min/day for five days/week of moderate-intensity activity (e.g., brisk walking), may lower the risk of GAD over time among older adults.

The Impact of an Outdoor Motor-Cognitive Exercise Programme on the Health Outcomes of Older Adults in Community Settings: A Pilot and Feasibility Study

Physical and cognitive exercises can prevent or at least mitigate the symptoms of certain diseases and help older adults perform a range of daily functions. Yet, most seniors do not meet the World Health Organisation's recommended guidelines for physical activity. The objective of this study is to promote and maintain the physical and cognitive capacity of older adults by implementing a feasible and effective low-threshold, age-appropriate, motor-cognitive training outdoors. In the German city of Chemnitz, citizens aged 60 years and older participated in a quasi-randomised intervention trial. Exercises to train coordination, strength, endurance, and cognition were integrated into a 12-week outdoor motor-cognitive exercise programme. Both the physical (e.g., 6MWT) and cognitive skills (e.g., TMT B) of the intervention group (n = 41) and control group (no intervention, n = 58) were measured before (T1) and after (T2) completion of the exercise programme. Some of the participants' physical and all their cognitive measures improved. Neurocognitive performance (DSST) showed a significant time × group interaction effect (F(1,95) = 6.943, p = 0.010, ηp2 = 0.068). Sex and age were found to be influencing factors. We consider our exercise programme to be successfully implemented, well received by the participants, and feasible and useful to promote the continued exercise of daily functions as part of healthy aging in community-dwelling older adults.

Association of habitual physical activity with depression and anxiety: a multicentre cross-sectional study

OBJECTIVE

Despite the known benefits of physical activity, the effect of habitual physical activity (HPA) on depression and anxiety remains unclear. This study aimed to investigate the association of HPA with the risk of depression and anxiety among Chinese adults, with the consideration of disease severity.

METHODS

The participants in this multicentre cross-sectional study were from the nationwide survey of the psychology and behaviour of Chinese residents. Depression and anxiety were measured using the nine-item Patient Health Questionnaire and seven-item Generalised Anxiety Disorder scale. HPA was assessed by the short form of the International Physical Activity Questionnaire. Crude and adjusted ORs with their 95% CIs were estimated by using ordinal logistic regression.

RESULTS

Of the 19 798 participants, 3901 (19.7%) had anxiety and 8914 (45.02%) had depression. Compared with inactive participants, depression risk in individuals reporting low, median and high volume HPA was reduced by 23% (OR 0.77, 95% CI 0.66 to 0.89), 21% (OR 0.79, 95% CI 0.68 to 0.90) and 13% (OR 0.87, 95% CI 0.78 to 0.98), respectively, after adjustment for confounder. No significant association of HPA with anxiety risk was observed.

CONCLUSION

Participation in HPA, whether low, median or high volume, was associated with a lower risk of depression compared with inactive participation, while no significant association was observed between HPA and anxiety.

"That's like therapy"-A qualitative study on socially disadvantaged women's views on the effects of a community-based participatory research project on their health and health behavior

Background

Regular physical activity has positive effects on both physical and mental health. Nevertheless, socially disadvantaged women are often insufficiently physically active. Through needs-based physical activity offers, community-based participatory research (CBPR) projects have the potential to reach these women and increase the effectiveness of physical activity interventions by supporting women's empowerment, health, and health behaviors. This study aimed to examine socially disadvantaged women's views on the effects of long-term participation in Bewegung als Investition in Gesundheit (BIG, i.e., movement as an investment in health), a long-standing German CBPR project, on their health and health behavior.

Methods

Semi-structured qualitative interviews were conducted with 30 participating women at five BIG sites across Germany between April and August 2022. The interviews were recorded, transcribed verbatim, and analyzed using framework analysis.

Results

Women reported that participation in BIG classes contributed to their physical, mental, and social health. For many women, the positive effects on their mental and social wellbeing were most important. In addition to increased fitness and improved physical endurance, many participating women were able to expand their social networks, thus receiving further social support, and improve their self-esteem, self-confidence, and self-efficacy. Furthermore, participation in BIG physical activity classes positively influenced the health awareness of many women helping them to improve their activity level and diet over time.

Conclusion

Our results suggest that CBPR projects, such as the BIG project, can increase physical activity among socially disadvantaged groups and contribute to their overall health and wellbeing. CBPR projects could thus be considered a key element of health promotion for this target group. Future interventional research is required to confirm and further explore the effects of CBPR interventions and to examine whether the effects can be replicated in other settings.

Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use

Background

There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however.

Objective

The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons.

Methods

Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency.

Results

From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses.

Conclusion

This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.

Dose-response effects of exercise on mental health in community-dwelling older adults: Exploration of genetic moderators

Background/Objective

(1) Examine the role of exercise intensity on mental health symptoms in a community-based sample of older adults. (2) Explore the moderating role of genetic variation in brain-derived neurotrophic factor (BDNF) and apolipoprotein E (APOE) on the effects of exercise on mental health symptoms.

Method

This study is a secondary analysis of a three-arm randomized controlled trial, comparing the effects of 6 months of high-intensity aerobic training vs. moderate-intensity aerobic training vs. a no-contact control group on mental health symptoms assessed using the Depression, Anxiety, and Stress Scale (DASS). The BDNF Val66Met polymorphism and APOE ε4 carrier status were explored as genetic moderators of exercise effects on mental health symptoms.

Results

The exercise intervention did not influence mental health symptoms. The BDNF Val66Met polymorphism did not moderate intervention effects on mental health symptoms. APOE ε4 carrier status moderated the effect of intervention group on perceived stress over 6 months, such that APOE ε4 carriers, but not non-carriers, in the high-intensity aerobic training group showed a decline in perceived stress over 6 months.

Conclusions

APOE ε4 carrier status may modify the benefits of high-intensity exercise on perceived stress such that APOE ε4 carriers show a greater decline in stress as a result of exercise relative to non-APOE ε4 carriers.

Exposure traced in daily life: improvements in ecologically assessed social and physical activity following exposure-based psychotherapy for anxiety disorders

BACKGROUND

Although exposure-based cognitive-behavioral therapy for anxiety disorders has frequently been proven effective, only few studies examined whether it improves everyday behavioral outcomes such as social and physical activity.

METHODS

126 participants (85 patients with panic disorder, agoraphobia, social anxiety disorder, or specific phobias, and 41 controls without mental disorders) completed smartphone-based ambulatory ratings (activities, social interactions, mood, physical symptoms) and motion sensor-based indices of physical activity (steps, time spent moving, metabolic activity) at baseline, during, and after exposure-based treatment.

RESULTS

Prior to treatment, patients showed reduced mood and physical activity relative to healthy controls. Over the course of therapy, mood ratings, interactions with strangers and indices of physical activity improved, while reported physical symptoms decreased. Overall results did not differ between patients with primary panic disorder/agoraphobia and social anxiety disorder. Higher depression scores at baseline were associated with larger changes in reported symptoms and mood ratings, but smaller changes in physical activity CONCLUSIONS: Exposure-based treatment initiates increased physical activity, more frequent interaction with strangers, and improvements in everyday mood. The current approach provides objective and fine-graded process and outcome measures that may help to further improve treatments and possibly reduce relapse.

Physical Activity and Neuropsychological Functioning in Older Adults

Research has identified a positive relationship between physical activity and neuropsychological functioning across the lifespan. The present study further examined the relationship between physical activity, depression, anxiety, and cognitive functioning in community-dwelling older adults (ages 65-96) who completed an outpatient neuropsychological evaluation (N = 526). Psychometrically sound and validated measures were used to assess depression, anxiety, and cognitive functioning. Analyses of covariance (ANCOVA) were conducted to examine differences between individuals who reported regularly engaging in physical activity and those who did not, after adjusting for demographic variables (age, education, and gender). Results indicated that physical activity was associated with better scores on measures of depression, anxiety, and cognitive functioning. Effect sizes for total scores on all measures were large, but there was a sizeable range of effect sizes (from small to large) for various cognitive domains. Smallest effect sizes were observed for subtests measuring language skills and visuospatial abilities, whereas largest effect sizes were seen in processing speed and memory. Results suggest that engaging in physical activity may be a beneficial non-pharmacological intervention for older adults. These findings underscore the importance of integrating physical activity programs in community and healthcare settings to foster mental and cognitive health in older populations.

Physical Activity, Alcohol, and Cigarette Use in Urological Cancer Patients over Time since Diagnosis

Urological cancers represent a substantial global public health concern, exerting far-reaching effects on both individuals and their families. There is an urgent need to comprehensively understand the transformations in patients' lifestyles and behaviors, given their critical role in the treatment process and overall well-being. This study, involving 128 urological cancer patients, aims to investigate changes in physical activity levels, problematic drinking behaviors assessed through the Alcohol Use Disorders Identification Test (AUDIT), and smoking habits assessed using the Fagerström Test for Nicotine Dependence (FTND) over four distinct time intervals over the subsequent three years from the time of diagnosis and among individuals diagnosed more than three years ago. The results reveal a significant decrease in physical activity levels between study intervals (p < 0.0001), declining from 69% to 45% between the first and second post-diagnosis assessments. Furthermore, the highest levels of problematic substance use, indicated by mean scores, were noted in the first year following diagnosis (AUDIT: 4.20, p = 0.01; FTND: 4.83, p = 0.08). Given the significant impact of physical activity on the prospects of recovery, it is imperative to delve more deeply into the factors contributing to this decline and devise targeted interventions for its improvement. In the context of substance use, it is essential to ascertain whether the initially high levels are a result of coping with the cancer diagnosis or represent a turning point at which patients modify their behaviors and cease their addiction. A more thorough understanding of this phenomenon would enhance the effectiveness of precisely focused interventions.

Accelerometer-measured physical activity at 3 months as a predictor of symptoms of depression and anxiety 1 year after stroke: a multicentre prospective cohort study in central Norway

OBJECTIVES

To study sedentary behaviour and physical activity at 3 months as predictors for symptoms of depression and anxiety at 1-year post-stroke.

DESIGN

A prospective cohort study.

PATIENTS

Patients with first-ever ischaemic stroke.

METHODS

Mood was assessed 3- and 12-months post-stroke using the Hospital Anxiety and Depression Scale. Sedentary behaviour and physical activity were measured using accelerometry 3 months post-stroke.

RESULTS

A total of 292 participants (116 (39.7%) females; mean age 71.7 (standard deviation 11.3) years) were included. At 12 months, 16.7% experienced depression and 19.5% anxiety, respectively. Adjusting for age and sex, regression analysis showed that comorbidity burden (β 0.26; 95% confidence interval (95% CI) 0.02, 0.51; p = 0.038), stroke severity (β 0.22; 95% CI 0.10, 0.35; p = 0.001), functional disability (β 0.89, 95% CI 0.49, 1.30; p = 0.000), and global cognition (β-0.15; 95% CI -0.25, -0.05; p = 0.004) predicted depression. Multi-adjusted analysis showed sedentary behaviour and physical activity did not significantly predict depression or anxiety (p > 0.05).

CONCLUSION

Sedentary behaviour and physical activity did not significantly predict mood after stroke. Comorbidity burden, stroke severity, functional disability, and global cognition were identified as possible predictors of depression. More research is needed to determine the impact of physical activity on depression and anxiety symptoms.

Higher physical activity level and perceived social support is associated with less psychological distress in people with anxiety

Introduction

Anxiety is one of the most prevalent mental illnesses in first world societies, generating discomfort in the people who suffer from it, and high expenses and economic losses in the society. The physical activity (PA) performed, together with the perceived social support (PSS) by people with anxiety could be related to the psychological distress of people with anxiety.

Objectives

To study the relationships between mental health and its dimensions, through Golberg's General Health Questionnaire (GHQ12), and the level of PA (PAL) and the PSS in the Spanish adult population with anxiety.

Hypothesis

A higher PAL, and a higher PSS, is related to a lower psychological distress in this population.

Design and Methodology

This study included 1,661 adults with anxiety, residents in Spain. It was a cross-sectional study with data obtained from the Spanish National Health Survey. A Kolmogorov-Smirnov test was applied to examine the data distribution of the variables. The median and interquartile range were used to characterize the sample for continuous variables, and absolute and relative frequencies were used for categorical variables. The Mann-Whitney U test was used to examine the differences between sexes. Dependence between PAL and sex was studied using the chi-square statistic. A Krustal-Wallis test was used to evaluate the existence of differences in the baseline medians on the GHQ-12, according to PAL level. Finally, the correlations between mental health and its dimensions with PAL and the Duke-UNC-11 scores were analysed, obtaining Spearman's rho and Pearson's correlation coefficient.

Results

Moderate inverse correlations were found between the GHQ-12 and: PAL (rho: -0.219); PSS (r: -0.347). PAL and PSS presented moderate inverse correlations with successful coping (rho: -0.206 and r: -0.325), self-esteem (rho: -0.222 and r: -0.333) and stress (rho: -0.158 and r: -0.288).

Conclusions

Greater PAL and social support are associated with reduced psychological distress in people with anxiety.

Barriers to and Facilitators of Physical Activity: A Qualitative Study from the Perspective of Individuals Living with Sight Loss in Cambridgeshire

Physical inactivity is a prevalent concern amongst adults living with sight loss. It is essential to understand why these individuals are inactive and how we can increase physical activity levels among them. Therefore, this study aims to explore the barriers and facilitators to physical activity for individuals living with sight loss. Seven individuals with self-reported sight loss living in Cambridgeshire were recruited for three focus groups. Focus group data were analysed using thematic analysis to identify key themes. Seven themes which represented a barrier, or a facilitator were identified: transport, accessing information, one size fits all, negative previous experience, visually impaired sport, women in disability sport, and taster days. To increase physical activity levels amongst those living with sight loss, interventions need to be focused on the organisational level. This includes producing more accessible environments that can be produced by providing training for sport and physical activity professionals and by ensuring the physical environment is inclusive for those living with sight loss.

Age group differences in psychological distress and leisure-time exercise/socioeconomic status during the COVID-19 pandemic: a cross-sectional analysis during 2020 to 2021 of a cohort study in Japan

Objective

This study aimed to determine the association between psychological distress and leisure-time exercise/socioeconomic status by age group, using data from a cohort study in Japan during the COVID-19 pandemic.

Methods

This cross-sectional study was conducted among participants in the ME-BYO cohort, aged 20-85 years, living or working in Kanagawa, Japan. A questionnaire was disseminated to 1,573 participants (51.7% men) between December 2020 and March 2021. The questionnaire items included psychological distress (using the 6-item Kessler Psychological Distress Scale [K6]), leisure-time exercise, and socioeconomic status. Multivariate analyses were conducted using logistic regression analysis for each age group.

Results

We found that 47.4% of 20-39-year-olds, 40.6% of 40-64-year-olds, and 28.3% of 65-85-year-olds experienced psychological distress (K6: ≥5 points). For those aged 20-39 years, leisure-time exercise (odds ratio [OR] (95% confidence interval) = 0.45 (0.28-0.73)) and higher annual household income [0.53 (0.32-0.90)] were associated with less psychological distress. For those aged 40-64 years, older age was associated with less psychological distress, while full-time work [1.98 (1.05-9.71)] was associated with more psychological distress. In the 65-85-year age group, higher education and higher annual income tended to be associated with less psychological distress. For those over 40 years of age, living with other(s) was associated with reduced psychological distress.

Conclusion

In the general population of Japan, not engaging in leisure-time exercise and low income affect psychological distress among young adults. Further detailed studies are needed to consider overall physical activity, job type, and work style.

Exercise as a behavioral approach to improve mood in persons with traumatic brain injury

Mood disturbance is a common, long-term, negative consequence of traumatic brain injury (TBI) that is insufficiently addressed by most traditional treatment modalities. A large body of evidence supports the efficacy of exercise training (ET) to broadly improve mood, as measured most often by the Profile of Mood States (POMS). However, this behavioral approach is not used nearly enough in the TBI population, and when it is, mood is rarely measured. This scoping review will evaluate the use of POMS as a mood measure in TBI research and to establish a rationale for using ET as a behavioral approach to broadly improve mood in persons with TBI.

Physical activity as a mediator of the association of body mass index change with anxiety/depression symptoms in Brazilian adults during COVID-19

BACKGROUND

the COVID-19 pandemic has impacted people's behaviors and mental health around the world.

AIM

to verify the mediating role of physical activity (PA) level in the relationship between body mass index (BMI) and anxiety and depression symptoms.

METHODS

this is a cross-sectional study with Brazilian adults aged ≥ 18 years (n = 2,000, 59.6 % women) selected by the nonprobabilistic snowball method through digital means of communication (WhatsApp®, Telegram®, Facebook®, Twitter®, e-mails). Linear regression models were fitted for PA level mediation analyses in the relationship between BMI and anxiety/depression symptoms.

RESULTS

significant differences were found between the active/not overweight group and the other three groups (active/overweight, insufficiently active/not overweight and insufficiently active/overweight [p < 0.001]) for anxiety/depression after adjusting for age, gender, chronic diseases, alcohol consumption, and smoking. When testing the mediating role of daily PA in the association between BMI and anxiety/depression symptoms, BMI was negatively associated with daily PA in the first regression equation (p < 0.001); in the second, BMI was positively related to anxiety/depression symptoms (p < 0.001); and in the third, daily PA showed an inverse relationship with anxiety/depression symptoms (p < 0.001), and although BMI remained negatively associated with anxiety/depression symptoms, these associations maintained their statistical significance.

CONCLUSIONS

the results suggest that the effect of BMI on anxiety and depression was partially mediated by daily PA.

Physical activity in childhood and adolescence and future depressive symptoms: an 11-year prospective cohort study

BACKGROUND

Physical activity (PA) can reduce young peoples' risk of depressive symptoms. Associations between PA and depressive symptoms are often investigated over timeframes spanning minutes to weeks. Less is known about whether childhood/adolescent PA can predict depressive symptoms in early adulthood.

METHODS

Using a nationally representative sample from Ireland, latent growth mixture modelling was performed to investigate the extent to which different PA trajectories existed from ages 9-17, whether gender, weight status, and socio-economic deprivation at age 9, predicted PA trajectories from ages 9-17, and whether trajectory class membership predicted depressive symptoms at age 20.

RESULTS

A 4-class solution was the best fit to the data (AIC = 52 175.69; BIC = 52 302.69; ssaBIC = 52 245.49; entropy = 1.00). Classes were labelled according to their baseline PA and slope of their trajectory: 'High-Decreasers'; 'Moderate-Decreasers'; 'Moderate-Stable'; and 'Low-Increasers'. A negative linear association existed between activity trajectory and the likelihood class members were female, overweight or socioeconomically deprived at age 9. The most active class (High-Decreasers) were significantly less likely to report depressive symptoms at age 20 than other classes.

CONCLUSIONS

Multiple PA trajectories exist throughout childhood and adolescence although differences in PA levels reduced over time. The most/least active children continued to be the most/least active throughout adolescence. Those most active were least at risk of depressive symptoms in early adulthood. Being female, overweight or experiencing deprivation at age 9 were all risk factors for inactivity throughout adolescence. Findings have implications for public health and PA promotion in young people.

Gender-Based Analysis of the Association Between Mental Health, Sleep Quality, Aggression, and Physical Activity Among University Students During the COVID-19 Outbreak

COVID-19 has spread throughout the world, resulting in significant morbidity, mortality, and negative psychological effects among general population. However, university students are particularly vulnerable in terms of mental health. The present study evaluated the association between mental health, quality of sleep, aggression, and physical activity in university students in Mexico after 1 year of dealing with the COVID-19 pandemic in Mexico, including a gender-sensitive analysis. Participants (935 university students) completed an online questionnaire which collected information regarding demographic data, psychological distress (IES-R scale), depression, anxiety, and stress (DASS-21), aggressiveness Buss-Perry Aggressive Questionnaire, sleep quality (PSQI) and physical activity (IPAQ-S). Findings showed that female students showed significantly higher scores in psychological distress, anxiety, stress scores and sleep quality, as compared to male students. By contrast, male students showed significantly higher scores on aggressiveness than female students. In addition, on physical activity, females performed significantly higher MET-min/week on moderate and high levels. Finally, liner regression model accounted for approximately 73.5% of the variance in DASS-21 scores, with the body mass index, IES-R, Pittsburgh Sleep Quality Index, and IPAQ subscales, emerging as significant individual (positive) predictors. Therefore, the pandemic affected female and male students differently. Female students reported more psychological distress, anxiety, and stress while male students reported higher aggressiveness. The differences observed may be due to physiological differences, the response to stress, and differences in sensitivity to life events.

How to develop young physical activity leaders? A Delphi study

The International Society for Physical Activity and Health advocates for increased capability of the physical activity workforce as a key ingredient to a system-based approach. Young leader programmes are gaining traction globally as peers are a primary influence on young people and positive role models are important for increasing or maintaining physical activity. Yet, there is limited understanding of 'what works' for training young physical activity leaders. This study aims to develop a consensus on how to identify and support young people to become physical activity leaders. An iterative three-phased mixed methods Delphi consensus approach. A rapid review focused on the feasibility, acceptability and impact of existing young leader physical activity training (phase one); focus groups (n = 3) and interviews (n = 6) with 15 practitioners and young leaders to examine young physical activity leader training needs (phase two); and a three-round questionnaire process (phase three). Stakeholders (n = 43) from across the public, voluntary and education sectors, academics and young leaders completed all questionnaires. A consensus was reached for 75 statements related to: young leader traits prior to and following training, recruitment methods, training content, delivery format and context, relationships, incentives, and skill development. The Delphi process, combining insight from multi-sectoral stakeholders, identified a range of factors that underpin young leader training programmes. These factors should be applied to develop a curriculum and comprehensive training programme to provide young leaders with the required capability to be effective within their roles, and ultimately support an increase in physical activity amongst children and young people.

Adolescents' Perspectives on Skateboarding and Injury Risk: The Benefits Outweigh the Risks

OBJECTIVE

Skateboarding is an increasingly popular sport among youth, despite the fact that children and adolescents are the age groups most frequently injured when skateboarding. A greater understanding of the psycho-social factors that motivate participation in skateboarding, including why youth return to the sport after serious injury from skateboarding, is needed to inform injury prevention efforts. This study addressed that gap in knowledge.

METHODS

Twenty-six Canadian adolescent skateboarders 14-17 years of age (20 males and 6 females) who had previously sustained medically attended injuries while skateboarding participated in individual interviews to explore their perspectives on skateboarding and injury risk, including reasons for returning to the sport after injury.

RESULTS

Thematic analyses revealed that participants perceived many unique benefits from skateboarding, including interpersonal benefits, mental and physical health benefits, pleasure, personal growth, and identity development. Participants uniformly identified that a major drawback was the risk of injury, with trickle-down effects of injury including a loss of social contacts (e.g., missing friends), challenges to individual identity from not participating, and injury-specific negative outcomes (e.g., pain, physical limitations). When exploring reasons participants returned to the sport and to the trick or activity that precipitated their injury, the primary theme identified was that the benefits of skateboarding significantly outweighed the costs associated with potential re-injury.

CONCLUSION

Results paint a nuanced picture of psycho-social factors that impact youths' skateboarding and decisions to return to the sport after injury. Implications for injury prevention are discussed.

Nonpharmacological approaches for pain and symptoms of depression in people with osteoarthritis: systematic review and meta-analyses

People with osteoarthritis often experience pain and depression. These meta-analyses examined and compared nonpharmacological randomized controlled trials (RCTs) for pain and symptoms of depression in people living with osteoarthritis. RCTs published up until April 2022 were sourced by searching electronic databases EMBASE, PUBMED & MEDLINE, Web of Science, CINAHL and PEDro. Random-effects meta-analyses were performed to calculate pooled effect sizes (ES) and 95% confidence intervals (CI) for pain and depression. Subgroup analyses examined intervention subtypes. For pain, 29 interventions (n = 4382; 65 ± 6.9 years; 70% female), revealed a significant effect on reducing pain (ES = 0.43, 95% CI [0.25, 0.61], p < 0.001). Effect sizes were significant (p < 0.001) for movement meditation (ES = 0.52; 95% CI [0.35, 0.69]), multimodal approaches (ES = 0.37; 95% CI [0.22, 0.51]), and psychological therapy (ES = 0.21; 95% CI [0.11, 0.31]), and significant (p = 0.046) for resistance exercise (ES = 0.43, 95% CI [- 0.07, 0.94]. Aerobic exercise alone did not improve pain. For depression, 28 interventions (n = 3377; 63 ± 7.0 years; 69% female), revealed a significant effect on reducing depressive symptoms (ES = 0.29, 95% CI [0.08, 0.49], p < 0.001). Effect sizes were significant for movement meditation (ES = 0.30; 95% CI [0.06, 0.55], p = 0.008) and multimodal interventions (ES = 0.12; 95% CI [0.07, 0.18], p < 0.001). Resistance/aerobic exercise or therapy alone did not improve depressive symptoms. Mind-body approaches were more effective than aerobic/resistance exercise or therapy alone for reducing pain and depression in people with osteoarthritis.Systematic review registration: PROSPERO CRD42022338051.

Physical Activity During Adolescence and Mental Health in Early Adulthood: Findings From the 1993 Pelotas Birth Cohort Study

BACKGROUND

Low prevalence of physical activity (PA) and a high prevalence of mental health problems are common among youth. The aim of this study was to evaluate the association between PA during adolescence and depression and anxiety disorders in young adulthood.

METHODS

Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analyzed. Leisure-time PA and total PA (leisure plus commuting) were evaluated at 11, 15, and 18 years using self-reported data. PA was evaluated at each age separately and during adolescence, considering the number of times participants reached PA recommendations. Depression and anxiety were assessed through Mini International Neuropsychiatric Interview at 22 years. Crude and adjusted association analyses were performed using Poisson regression with robust error variance, providing prevalence ratios and 95% confidence intervals.

RESULTS

Three thousand two hundred and forty-seven participants were included in the study. In the adjusted analyses, active participants in leisure-time PA (≥300 min/wk) and total PA at 11 years were less likely to be depressed at age 22 (prevalence ratios: 0.54; 95% confidence interval, 0.33-0.89; prevalence ratios: 0.63; 95% confidence interval, 0.41-0.97). For leisure-time PA, the more PA recommendations were met during adolescence, the lower the prevalence of depression. There was no association when PA variables were evaluated separately at 15 and 18 years and between PA and anxiety after controlling for potential confounders.

CONCLUSIONS

Early adolescence appears to be a sensitive period for PA benefits on depression in early adulthood. The more timepoints reaching PA recommendations during adolescence, the lower the risk of depression. On the other hand, PA during adolescence was not associated with anxiety in young adults.

The associations between social support change and physical activity trajectory from late adolescence to young adulthood

BACKGROUND

Previous research examined the associations between social support and physical activity. However, little is known about the associations between social support change and trajectories of physical activity during the transition from late adolescence to young adulthood.

METHODS

The current study sought to examine these issues among 434 Chinese college students (Mage = 19.15, SDage = 0.61; 46.1% male), who completed questionnaires regarding demographics, physical activity, family support change, and peer support change across three waves (the data from one of the waves was retrospective).

RESULTS

After controlling for covariates, the findings revealed that: (a) there was an increase in overall physical activity and duration, but a decrease in frequency during the transition from late adolescence (the second year of high school) to young adulthood (the third year of college); (b) family support change did not contribute to trajectories of physical activity, while peer support change significantly predicted the trajectory of overall physical activity, duration, and frequency.

CONCLUSIONS

The findings extend the literature on physical activity from a developmental perspective by revealing different trends among physical activity duration and frequency, and unpacking different effects of family and peer support change on trajectories of physical activity.

Exercise is the Most Important Medicine for COVID-19

ABSTRACT

COVID-19 infection and long COVID affect multiple organ systems, including the respiratory, cardiovascular, renal, digestive, neuroendocrine, musculoskeletal systems, and sensory organs. Exerkines, released during exercise, have a potent crosstalk effect between multiple body systems. This review describes the evidence of how exerkines can mitigate the effects of COVID-19 in each organ system that the virus affects. The evidence presented in the review suggests that exercise should be considered a first-line strategy in the prevention and treatment of COVID-19 infection and long COVID disease.

Testing the causal relationships of physical activity and sedentary behaviour with mental health and substance use disorders: a Mendelian randomisation study

Observational studies suggest that physical activity can reduce the risk of mental health and substance use disorders. However, it is unclear whether this relationship is causal or explained by confounding bias (e.g., common underlying causes or reverse causality). We investigated the bidirectional causal relationship of physical activity (PA) and sedentary behaviour (SB) with ten mental health and substance use disorders, applying two-sample Mendelian Randomisation (MR). Genetic instruments for the exposures and outcomes were derived from the largest available, non-overlapping genome-wide association studies (GWAS). Summary-level data for objectively assessed PA (accelerometer-based average activity, moderate activity, and walking) and SB and self-reported moderate-to-vigorous PA were obtained from the UK Biobank. Data for mental health/substance use disorders were obtained from the Psychiatric Genomics Consortium and the GWAS and Sequencing Consortium of Alcohol and Nicotine Use. MR estimates were combined using inverse variance weighted meta-analysis (IVW). Sensitivity analyses were conducted to assess the robustness of the results. Accelerometer-based average PA was associated with a lower risk of depression (b = -0.043, 95% CI: -0.071 to -0.016, effect size[OR] = 0.957) and cigarette smoking (b = -0.026; 95% CI: -0.035 to -0.017, effect size[β] = -0.022). Accelerometer-based SB decreased the risk of anorexia (b = -0.341, 95% CI: -0.530 to -0.152, effect size[OR] = 0.711) and schizophrenia (b = -0.230; 95% CI: -0.285 to -0.175, effect size[OR] = 0.795). However, we found evidence of reverse causality in the relationship between SB and schizophrenia. Further, PTSD, bipolar disorder, anorexia, and ADHD were all associated with increased PA. This study provides evidence consistent with a causal protective effect of objectively assessed but not self-reported PA on reduced depression and cigarette smoking. Objectively assessed SB had a protective relationship with anorexia. Enhancing PA may be an effective intervention strategy to reduce depressive symptoms and addictive behaviours, while promoting sedentary or light physical activities may help to reduce the risk of anorexia in at-risk individuals.

The Association between 24 h Movement Guidelines and Internalising and Externalising Behaviour Problems among Chinese Preschool Children

This study examined the relationship between adherence to 24 h movement guidelines (24 h MGs) and internalising and externalising behavioural problems in Chinese children aged 3-6 years, with a specific focus on the differences between weekdays and weekends. The guidelines include recommendations for physical activity (PA), screen time (ST), and sleep duration (SD). The results indicated a stronger association between adherence to these guidelines and behavioural problems on weekends compared to weekdays. Specifically, the odds of experiencing internalising problems were 1.33 higher (95% CI: 1.05-1.69) when not satisfying all three behaviours compared to not satisfying one or two. Moreover, on weekends, when ST was not fulfilled, there was a higher likelihood of externalising behaviour problems compared to when it was fulfilled (OR, 1.18, 95% CI, 1.01-1.38), and when all three behaviours were not met, the likelihood was even higher (OR, 1.50, 95% CI, 1.04-2.18). Children who met all three guidelines had fewer internalising and externalising behavioural problems, suggesting a potential beneficial effect on mental health. The study revealed that a higher adherence to these recommendations corresponded to a lower risk of mental health problems. Additionally, higher screen time was linked to an increase in externalising behavioural issues. These findings underscore the importance of adherence to 24 h MGs for optimal mental health in children. Future interventions should consider these behavioural factors and incorporate strategies to promote adherence to these guidelines, particularly on weekends.

Assessing the implementation of physical activity-promoting public policies in the Republic of Ireland: a study using the Physical Activity Environment Policy Index (PA-EPI)

BACKGROUND

Government policy can promote physical activity (PA) as part of a multilevel systems-based approach. The Physical Activity Environment Policy Index (PA-EPI) is a monitoring framework which assesses the implementation of government policy by drawing on the experience of national stakeholders. This study is the first to assess the extent of policy implementation in the Republic of Ireland using the PA-EPI tool, and to provide information on how policy implementation can be improved, with the intention of maximizing its impact on population levels of PA.

METHODS

This mixed-methods research study, comprising eight steps, was carried out in 2022. Information documenting the evidence for implementation of PA policy, across all 45 PA-EPI indicators, was collected via systematic document analysis, and validated via survey and interview with government officials. Thirty-two nongovernment stakeholders rated this evidence on a five-point Likert scale. Aggregated scores were reviewed by stakeholders who collectively identified and prioritized critical implementation gaps.

RESULTS

Of the 45 PA-EPI indicators, one received an implementation rating of 'none/very little', 25 received a rating of 'low' and 19 received a 'medium' rating. No indicator was rated as fully implemented. The indicators that received the highest level of implementation related to sustained mass media campaigns promoting PA and PA monitoring. Ten priority recommendations were developed.

CONCLUSIONS

This study reveals substantial implementation gaps for PA policy in the Republic of Ireland. It provides recommendations for policy action to address these gaps. In time, studies utilizing the PA-EPI will enable cross-country comparison and benchmarking of PA policy implementation, incentivizing improved PA policy creation and implementation.

Comparing the efficacy of different types of exercise for the treatment and prevention of depression in youths: a systematic review and network meta-analysis

Purpose

Depression disorder is the most commonly diagnosed type of mental illness among youths. Although a plethora of evidence suggests a positive relationship between exercise and lower levels of depression in youths, the findings regarding the variation in magnitude of this relationship are inconclusive with respect to the preventive and therapeutic effects of different types of exercise. This network meta-analysis aimed to determine the best type of exercise for the treatment and prevention of depression in youths.

Methods

A comprehensive search of databases, including PubMed, EMBASE, The Cochrane Library, Web of Science, PsychINFO, ProQuest, Wanfang, and CNKI, was conducted to identify relevant research on exercise interventions for depression in youth populations. The risk of bias in the included studies was evaluated using Cochrane Review Manager 5.4 according to the Cochrane Handbook 5.1.0 Methodological Quality Evaluation Criteria. The network meta-analysis was performed using STATA 15.1 to calculate the standardized mean difference (SMD) of all concerned outcomes. The node-splitting method was used to test the local inconsistency of the network meta-analysis. Funnel plots were used to evaluate the potential impact of bias in this study.

Result

Utilizing data extracted from 58 studies (10 countries, 4,887 participants), we found that for depressed youths, exercise is significantly better than usual care in reducing anxiety (SMD = -0.98, 95% CI [-1.50, -0.45]). For non-depressed youths, exercise is significantly better than usual care in reducing anxiety (SMD = -0.47, 95% CI [ -0.66, -0.29]). In the treatment of depression, resistance exercise (SMD = -1.30, 95% CI [ -1.96, -0.64]), aerobic exercise (SMD = -0.83, 95% CI [-1.10 -0.72]), mixed exercise (SMD = -0.67, 95% CI [-0.99, -0.35]), and mind-body exercise (SMD = -0.61, 95% CI [-0.84, -0.38]) all showed significant efficacy over usual care. For the prevention of depression, resistance exercise (SMD = -1.18, 95% CI [-1.65, -0.71]), aerobic exercise (SMD = -0.72, 95% CI [-0.98, -0.47]), mind-body exercise (SMD = -0.59, 95% CI [-0.93, -0.26]), and mixed exercise (SMD = -1.06, 95% CI [-1.37 to -0.75]) were all significantly effective compared to usual care. According to the test of the surface under the cumulative ranking score (SUCRA), the ranking of exercises for the treatment of depression in depressed youths is as follows: resistance exercise (94.9%) > aerobic exercise (75.1%) > mixed exercise (43.8%) > mind-body exercise (36.2%) > usual care (0%). For the prevention of depression in non-depressed youths, resistance exercise (90.3%) > mixed exercise (81.6%) > aerobic exercise (45.5%) > mind-body exercise (32.6%) > usual care (0%). Resistance exercise thus had the best comprehensive effect on both the treatment and prevention of depression in youths (clusterank value = 1914.04). Subgroup analyses show that a frequency of 3-4 times per week, a duration of 30-60 min, and a length of more than 6 weeks were found to be the most effective interventions for depression (P > 0.001).

Conclusion

This study provides compelling evidence that exercise is a viable intervention for improving depression and anxiety in young individuals. In addition, the study emphasizes the importance of selecting the appropriate type of exercise to optimize treatment and prevention. Specifically, the results suggest that resistance exercise, performed 3-4 times per week, with sessions lasting 30-60 min and a length of more than 6 weeks, yields optimal results for the treatment and prevention of depression in young individuals. These findings have significant implications for clinical practice, particularly given the challenges associated with implementing effective interventions and the economic burden of treating and preventing depression in young people. However, it is worth noting that additional head-to-head studies are necessary to confirm these findings and strengthen the evidence base. Nevertheless, this study provides valuable insights into the role of exercise as a potential treatment and preventative measure for depression in young people.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=374154, identifier: 374154.

Physical Activity and Depression and Anxiety Disorders: A Systematic Review of Reviews and Assessment of Causality

Introduction

Globally, depressive and anxiety disorders are the leading contributors to mental ill health. Physical activity reduces symptoms of depression and anxiety and has been proposed as an adjunct treatment therapy for depression and anxiety. Prospective studies suggest that physical activity may reduce the incidence of depression and anxiety. We conducted a systematic review of reviews with the aim to provide a comprehensive overview of available epidemiologic evidence on the strength of the association between physical activity and incident cases of depression and anxiety and to assess the likelihood of these associations being causal.

Methods

We searched Embase and PubMed databases for systematic reviews published between January 1, 2000 and March 19, 2020 that reported findings on the strength of association between physical activity and incidence of depression and anxiety. We updated this search to October 15, 2022. Two reviewers independently assessed the methodologic quality of the included reviews using the Assessment of Multiple Systematic Reviews rating scale. We carried out a narrative synthesis of the evidence. We used the Bradford Hill criteria to assess the likelihood of associations being causal.

Results

The initial search yielded 770 articles, of which 4 remained for data extraction. Two of the included reviews were scored as high quality, and 2 were scored as low quality. From the 2 included reviews that reported pooled estimates, people with high physical activity levels were found to have a decreased risk of incident depression (adjusted RR=0.83, 95% CI=0.76, 0.90) and reduced odds of developing anxiety (adjusted OR=0.74,95% CI=0.62, 0.88) when compared with those with low physical activity levels. We assessed physical activity to be probably causally related to both depression and anxiety.

Discussion

Our evidence is drawn from systematic reviews of observational data. Further high-quality studies, such as randomized control trials, would help to strengthen the evidence base of the associations between physical activity and depression and anxiety. Nonetheless, our findings provide empirical support for the consideration of physical activity in strategies for the prevention of mental ill health.

Pet ownership and lifestyle behaviours of immunosuppressed individuals and their relatives in the context of COVID-19 pandemic

The COVID-19 pandemic and containment measures will likely have a detrimental impact on immunosuppressed individuals' lifestyle behaviours. Increasing evidence suggests that pet ownership is positively associated with healthier lifestyle. Yet, no study has investigated the potential benefits of pet ownership on lifestyle behaviours of immunosuppressed individuals, a population at increased risk of COVID-19 complications. This study aims to examine 1) changes in light, moderate and vigorous intensity physical activity (LPA, MPA, VPA), sedentary time (SED), and sleep duration, assessed by comparing "before COVID-19 pandemic" and "past 7 days" (i.e., current, during pandemic) self-reported behaviours in immunosuppressed individuals and their relatives; 2) to assess if changes in lifestyle behaviours are associated with pet ownership status and whether age is a moderator of these associations. A convenience sample of 132 participants (65.2% female, 41.3% ≥55 years of age) provided self-reported LPA, MPA, VPA (days/week), SED and sleep (min/day) and pet ownership status using an online questionnaire (May-August 2020). Descriptive analyses, paired T-tests, Cohen's d effect size and linear regressions were conducted. Results show that participants reported a decrease in VPA (-0.56 days/week, d = 0.34; p < 0.01) and an increase in SED (106.79 min/day, d = -0.81; p < 0.01). Stratified analysis revealed that having at least one dog, compared to not owning pets, is associated with a reduced decline in LPA, MPA and VPA and an increase in sleep in participants aged < 55 years old only. Having a dog appears to be positively associated with healthy lifestyle behaviours in younger and middle age immunosuppressed individuals.

Internet use time and mental health among rural adolescents in China: A longitudinal study

BACKGROUND

The digital divide between urban and rural adolescents is widening. Many existing studies have found an association between internet use and adolescent mental health, but few use longitudinal data to focus on rural adolescents. We aimed to identify the causal relationships between internet use time and mental health in Chinese rural adolescents.

METHODS

Using a sample of 3694 participants (aged 10-19) from the 2018-2020 China Family Panel Survey (CFPS). Fixed effects model, mediating effect model and instrumental variables method was used to evaluate the causal relationships between internet use time and mental health.

RESULTS

We find that more time spent on the internet has a significant negative effect on participants' mental health. This negative impact is stronger in female and senior students groups. Mediating effects analysis suggests that more time spent on the internet increase risk of mental health problems by reducing sleep duration and parent-adolescent communication. Further analysis find that online learning and online shopping is associated with higher depression scores, while online entertainment with lower depression scores.

LIMITATIONS

The data do not investigate the specific time spent on internet activities (e.g., learning, shopping, and entertainment), and the long-term impacts of internet use time and mental health have not been tested.

CONCLUSIONS

Internet use time has a significant negative impact on mental health by crowding out sleep duration and parent-adolescent communication. The results provide an empirical reference for the prevention and intervention of mental disorders in adolescents.

Association of the Practice of Physical Activity and Dietary Pattern with Psychological Distress before and during COVID-19 in Brazilian Adults

To verify the association between the practice of physical activity and dietary patterns and psychological distress before and during the lockdown due to COVID-19, a cross-sectional study was performed with 2000 Brazilians (mean [M] = 35.78 years; standard deviation [SD] = 11.20; 59.6% women) recruited through convenience sampling via digital media. Participants completed an electronic questionnaire containing sociodemographic and clinical information, nutritional patterns, physical activity, and psychological distress. Data were analyzed using descriptive statistics and multinomial regression. Before the COVID-19 lockdown, the chance of women presenting very high stress, in relation to men, was six times higher (OR = 6.32; 95% CI 4.20-9.51), a behavior that remained similar during the lockdown (OR = 6.63; 95% CI 4.40-10.00). Before the lockdown, insufficient physical activity doubled the chance of having very high stress in relation to those who engaged in physical activities six to seven times a week (OR = 2.11; 95% CI 1.10-4.02). However, during the lockdown, this probability was higher, from twice to 10 times the chance (OR = 10.19; 95% CI 4.85-21.41). Not exercising alone (OR = 2.18; 95% CI 1.52-3.11) and a decreasing physical activity frequency (OR = 2.28; 95% CI 1.40-3.71) were also associated with very high stress during the lockdown. Additionally, the consumption of smaller amounts of food showed an inverse association with very high stress (OR = 0.28; 95% CI 0.18-0.43). The maintenance of physical activity and an adequate eating frequency are measures that should be considered to cope with higher levels of anxiety and depression.

The Interplay Between Expected Psychological Responses to Exercise and Physical Activity in Analogue Generalized Anxiety Disorder: a Cross-sectional Study

BACKGROUND

Expectations for psychological responses to exercise are not well characterized, particularly in people at risk for anxiety-related illnesses. Given the substantial evidence for salutary effects of exercise on anxiety symptoms and emerging recognition for expectations as a critical mechanism of placebo/nocebo effects, this study explored the interplay between expectations and physical activity in young adults with and without analogue generalized anxiety disorder.

METHODS

Participants (N=470, 23.2±4.8 years, 63% female) completed a physical activity and mood survey, including a 7-day physical activity recall questionnaire, and a 20-item questionnaire designed to measure positive and negative expectations for psychological and perceptual responses to exercise, particularly expectations for symptoms in the generalized anxiety disorder symptom profile. Analogue generalized anxiety disorder status was determined using the Generalized Anxiety Disorder subscale of the Psychiatric Diagnostic Screening Questionnaire.

RESULTS

For select outcomes, expected exercise-induced changes significantly differed according to analogue generalized anxiety disorder (whole-body pain, sleep quality, psychological well-being, stress, relaxation) and active versus inactive (anxious mood, depressed mood, concentration, physical function, psychological well-being, relaxation) status. However, these findings did not survive corrections for multiple comparisons and the magnitude of these differences was small, approximating 0.25 standard deviations. Expectations for anxious (Spearman's ρ=-0.14, p≤0.002) and depressed mood (ρ=-0.15, p≤0.002), and psychological well-being (ρ=0.15, p≤0.001) were significantly associated with higher physical activity levels. Exercise expectations for anxious mood explained a significant, but small (+1.5%, p≤0.03), amount of variance in physical activity.

CONCLUSIONS

Expectations for exercise-induced improvements did not significantly differ between young adults based on analogue generalized anxiety disorder or physical activity status.

Depression, Anxiety and Antidepressants and Anxiolytics Use in Spanish Informal Caregivers according to the Physical Activity Frequency: EHSS 2014–2020

Depression and anxiety are two of the most common mental diseases both in formal and nonformal caregivers. Physical activity during leisure time seems to have benefits on their practitioner’s mental health. This study aimed to analyze the associations between physical activity frequency (PAF) and depression and anxiety status, as well as antidepressant and anxiolytic use in Spanish nonformal caregivers. A cross-sectional study with data from the 2014 and 2020 European Health Interview Surveys in Spain (EHSS) including 4520 Spanish nonformal caregivers was carried out. The PAF was found to be related to depression and anxiety, as well as antidepressants and anxiolytics use (p < 0.001), with the highest proportions of these variables found in the inactive population (p < 0.05), while the active and very active populations showed the lowest proportions (p < 0.05). Weak but statistically significant correlations were found between all variables of interest (p < 0.001). Being female, older, and dedicating more hours per week to caregiving and caring for nonfamily members were found to have increased risks of depression, anxiety and antidepressants or anxiolytics use. Nonformal caregivers who were not physically active during their leisure time had higher mental disorders and psychotropic drug use proportions than the active and very active caregivers. Thus, increasing nonformal caregivers’ PAF could be a protective tool.

Mental Health in Adults With ADHD: Examining the Relationship With Cardiorespiratory Fitness

OBJECTIVE

The mental health of adults with ADHD was compared to neurotypical controls, and associations between cardiorespiratory fitness (CRF) and mental health were examined.

METHOD

Seventy-two participants (n = 36 with ADHD) completed demographic questions assessing ADHD and mental health symptoms. CRF was estimated using the 6-Minute Walk Test and a self-perception question.

RESULTS

Those with ADHD had significantly poorer mental health outcomes than controls (p < .001), with 50% of adults with ADHD reporting moderate to extremely severe symptoms of depression, anxiety, and stress. Critically, lower CRF was associated with worse depression, anxiety, and stress (all p ≤ .03) across both groups. Within the ADHD group, those with higher estimated CRF had significantly lower stress. Among participants with less severe ADHD symptoms, those with higher perceived CRF had significantly lower depressive symptoms.

CONCLUSION

In our cross-sectional study, participants with ADHD had poorer mental health than neurotypical controls, and higher fitness was associated with better mental health.

Cognitive behavioural techniques reduce exercise anxiety and improve adherence to a resistance training program for people with anxiety-related disorders: A randomized controlled trial

Exercise is a cost-efficient alternative to other interventions for anxiety-related disorders (ARDs; e.g., psychotherapy, pharmaceutical) that is also associated with health benefits. Several exercise modalities, including resistance training (RT), have demonstrated efficacy at reducing symptoms of ARDs; however, there are challenges associated with effectively implementing such protocols, most notably, exercise avoidance or early discontinuation. Researchers have identified exercise anxiety as a contributor to exercise avoidance for people with ARDs. Exercise-based interventions for people with ARDs may need to include strategies for helping these individuals cope with exercise anxiety to facilitate long-term exercise engagement; however, research in this area is lacking. The primary purpose of this randomized controlled trial (RCT) was to examine the effects of combining cognitive behavioural techniques (CBT) with a RT program on changes in exercise anxiety, exercise frequency, disorder-specific anxiety symptoms, and physical activity for people with ARDs. A secondary purpose was to explore group differences in exercise motivation and exercise self-efficacy across time. A total of 59 physically inactive individuals with ARDs were randomized into either RT + CBT, RT, or waitlist (WL). Primary measures were assessed at baseline, weekly during the 4-week active phase, and at 1-week, 1-month, and 3-month follow-ups. Findings indicate both RT and RT + CBT can reduce exercise anxiety; however, the addition of CBT techniques may help facilitate improvements in exercise self-efficacy, reductions in disorder-specific anxiety, and increases in long-term exercise behaviour and vigorous physical activity. These techniques may be useful for researchers and clinicians alike in supporting individuals with ARDs interested in using exercise to cope with elevated anxiety.