Experimentally investigating the joint effects of physical activity and sedentary behavior on depression and anxiety: A randomized controlled trial

Cognitive Vulnerability to Mood Deterioration in an Exercise Cessation Paradigm

Mood deterioration in response to exercise cessation is well-documented, but moderators of this effect remain unknown. This study tested the hypothesis that physically active individuals with higher levels of cognitive vulnerability (i.e., tendencies towards negative thought content and processes in response to stress or negative mood states) are at greater risk for increased anxiety and depressive symptoms when undergoing exercise cessation. Community adults meeting recommended physical activity guidelines (N=36) participated in a 4-week prospective, longitudinal study with 2 weeks each of maintained exercise and exercise cessation. Cognitive vulnerability measures included dysfunctional attitudes, brooding rumination, and cognitive reactivity (i.e., change in dysfunctional attitudes over a dysphoric mood induction). Anxiety and depression symptoms increased during exercise cessation. Brooding emerged as a risk factor for increases in Tension scores on the Profile of Mood States-Brief during exercise cessation. Future studies should explore brooding as a mediator (i.e., potential mechanism) of exercise-induced mood deterioration.

The "STAR WARS: The First Jedi" Program-Effects of Gamification on Psychological Well-Being of College Students

Background: College students are particularly susceptible to developing mental health problems. Gamification can be a powerful teaching strategy to favor motivation and behavioral changes for the improvement of psychological well-being. Purpose: To analyze the effect of a 14-week gamification-based physical education teaching program on psychological well-being of college students. Materials and Methods: A total of 112 college students (21.22 ± 2.55 years) were recruited and assigned to a gamification-based group or a control group. The intervention group participated in a gamification-based program under the framework of "STAR WARS" science fiction sage. Participants from this group used a mobile app with a countdown timer and the way for them to gain lifetime was by doing physical activity (PA) and formative challenges. The control group did not experience the gamification approach itself as their classes were based on traditional methodology. They were asked to maintain their usual lifestyle and were not required to do PA. Emotional intelligence, personal initiative, entrepreneurial attitude, resilience, and self-efficacy were self-reported. Results: The gamification-based group showed a significantly higher improvement of emotional intelligence (P ≤ 0.006), personal initiative (P ≤ 0.033), entrepreneurial attitude (P < 0.001), resilience (P = 0.002), and self-efficacy (P < 0.001), compared with the control group. Overall effect sizes were of medium magnitude for emotional intelligence and personal initiative, large magnitude for entrepreneurial attitude, and small magnitude for resilience and self-efficacy. Conclusion: Gamification and the use of mobile apps may become powerful teaching strategies to motivate college students toward healthier lifestyle behaviors that have psychological well-being benefits.

The Associations of Physical Activity and Health-Risk Behaviors toward Depressive Symptoms among College Students: Gender and Obesity Disparities

Engaging in health-risk behaviors (HRBs) may be correlated with depressive symptoms among college students, but these relationships require more research. The purpose of this study was to examine the associations of physical activity levels (i.e., light [LPA] and moderate-vigorous [MVPA]) and HRBs (i.e., sedentary behavior [screen-based and non-screen-based behavior] and cigarette and e-cigarette tobacco use) with depressive symptoms in a sample of college students. Physical activity levels and HRBs were assessed through validated questionnaires. In total, 366 students participated (Mage = 22.59 ± 3.54; 60.1% female; 52.9% normal weight). E-cigarette use in males (β = 0.23, p < 0.05) and screen-based sedentary behavior in females (β = 0.14, p < 0.05) showed significant predictive utility toward depressive symptoms. In the overweight/obese group, screen-based sedentary behaviors (β = 0.19, p < 0.05) and e-cigarette use (β = 0.23, p < 0.01) showed significant predictive utility toward depressive symptoms. Females reported higher levels of depressive symptoms (Mfemale = 18.23 vs. Mmale = 14.81; η2 = 0.03) and less MVPA (Mmale = 52.83 vs. Mfemale = 41.09; η2 = 0.06) than males. Enhancing mental health by improving physical activity and eliminating HRBs should be tailored toward at-risk demographics.

Association between long-term sedentary behavior and depressive symptoms in U.S. adults

The study aimed to investigate the association between long-term sedentary behavior (LTSB) and depressive symptoms within a representative sample of the U.S. adult population. Data from NHANES 2017-2018 were used, encompassing information on demographics, depressive symptoms, physical activity (PA), and LTSB. Depressive symptoms were identified using the Patient Health Questionnaire (PHQ-9), with "depressive symptoms" defined as a PHQ-9 score of ≥ 5, and "moderate to severe depressive symptoms (MSDS)" defined as a PHQ-9 score of ≥ 10. PA and LTSB were assessed through the Global Physical Activity Questionnaire, where LTSB was interpreted as sedentary time ≥ 600 min. Restricted Cubic Spline (RCS) curves were utilized to observe potential nonlinear relationships. Binary Logistic regressions were conducted to analyze the associations. A total of 4728 participants (mean age 51.00 ± 17.49 years, 2310 males and 2418 females) were included in the study. Among these individuals, 1194 (25.25%) displayed depressive symptoms, with 417 (8.82%) exhibiting MSDS. RCS curves displayed increased risk of depressive symptoms with prolonged sedentary duration. Logistic regression models indicated significant associations between LTSB and depressive symptoms (OR 1.398, 95% CI 1.098-1.780), and LTSB and MSDS (OR 1.567, 95% CI 1.125-2.183), after adjusting for covariates. These findings suggest that LTSB may act as a potential risk factor for both depressive symptoms and MSDS in the studied population.

Physical Activity, Sedentary Time, and Psychosocial Functioning among Adults with Cancer: A Scoping Review

The post-treatment period (after the completion of primary cancer treatment) is a phase during which adults with cancer are particularly vulnerable to the physical and psychological side effects of treatment. Adopting healthy lifestyle habits during this time is essential to mitigate these effects. This scoping review investigated the associations of physical activity (PA) and sedentary time (ST) with two post-treatment psychosocial indicators among adults with cancer: psychological functioning and quality of life (QoL). An exhaustive search was performed in January 2023 across five databases, namely APA PsycInfo, MedLine, SPORTDiscuss, SCOPUS, and CINAHL, adhering to PRISMA guidelines for scoping reviews. Twenty articles met the inclusion criteria; 16 used a cross-sectional design, while 4 used a longitudinal one. PA and ST were assessed mainly with accelerometers (n = 17), and psychosocial indicators with self-reported questionnaires (n = 20). Most studies linked higher PA levels to reduced anxiety (n = 3) and depression (n = 4) symptoms, and elevated ST to higher psychological symptoms (n = 3). Opposite associations were observed for QoL (n = 5). Altogether, PA appeared to be more strongly related to psychological functioning and QoL than ST. This scoping review highlights associations of PA and ST with psychological functioning and QoL among adults with cancer in the post-treatment period. However, future studies must prioritize longitudinal designs to establish directionality.

Intercultural adaptation and influencing factors analysis of the Chinese version of the anxiety scale for the older adults in a long-term care population

Objective

The purpose of this study was to translate the Geriatric Anxiety Scale-Long-Term Care into Chinese and to assess its reliability and validity in a long-term care population, as well as to explore factors contributing to anxiety in older adults requiring long-term care.

Methods

The study recruited 399 older adults residents requiring long-term care and used the Brislin double translation-back-translation method to create the initial Chinese version of the Geriatric Anxiety Scale-Long-Term Care. The study used internal consistency and split-half reliability to assess the reliability of the scale, as well as exploratory factor analysis, validation factor analysis, and content validity to assess the validity of the scale. Linear regression was used to analyze the relationship between the independent variables and anxiety levels in the long-term care population.

Results

The Cronbach's coefficient value of the Chinese version of the Geriatric Anxiety Scale-Long-Term Care was 0.81, and the split-half reliability was 0.80. The results of exploratory factor analysis showed support for a one-dimensional factor structure. The results of the validation factor analysis indicated a good fit for the one-factor model. Gender (β = 0.190, 95% CI:0.540 ~ 1.546, p < 0.001), self-rated health (β = 0.220, 95% CI:0.379 ~ 0.953, p < 0.001), life satisfaction (β = -0.315, 95% CI: -1.355 ~ -0.734, p < 0.001) and participation in activities (β = -0.106, 95% CI: -1.122 ~ -0.084, p < 0.05) were significant predictors of anxiety levels in the long-term care population.

Conclusion

The Chinese version of the Geriatric Anxiety Scale-Long-Term Care has good reliability and validity in the long-term care population. The Geriatric Anxiety Scale-Long-Term Care is effective in assessing the anxiety level of the Chinese long-term care older adults population and provides an opportunity to detect and observe anxiety disorders in the long-term care population.

Relationship between lifestyle changes due to the COVID-19 pandemic and depression: Nationwide population-based research using Community Health Survey data in South Korea

AIMS

This study evaluated the association between depression and lifestyle changes due to the COVID-19 pandemic and evaluated this association in patients with chronic diseases.

METHODS

Data were obtained from the 2020 Community Health Survey in South Korea. This study included 212,806 participants and perceived changes in life patterns (sleep, food, and exercise) after the COVID-19 outbreak were measured. People with hypertension or diabetes were categorized as patients with chronic diseases and depression was defined as a score of ≥10 on the Patient Health Questionnaire-9.

RESULTS

Compared with before the COVID-19 pandemic, increased or decreased sleep, the consumption of instant food, and decreased physical activity were associated with increased depression. Compared with the general population, patients with chronic diseases showed increased depression, with or without medication. Additionally, among patients with chronic diseases not taking medication, increased physical activity was associated with reduced depression, whereas reduced physical activity was associated with increased depression in both younger and older groups.

CONCLUSIONS

This study found that unhealthy lifestyle changes during the COVID-19 pandemic were associated with increased depression. Maintaining a certain lifestyle is important for mental health. Chronic disease patients need appropriate disease management, including physical activity.

The effects of physical exercise on anxiety symptoms of college students: A meta-analysis

Objective

This study aimed to evaluate the effect of an exercise intervention on improving and alleviating anxiety symptoms in college students with a meta-analytical approach.

Methods

Several databases (e.g., PubMed, Embase, and the Cochrane Library) were used to search for randomized controlled trials (in short, RCTs) on interventions for physical exercise or aerobic exercise in college students with anxiety symptoms. Stata software, version 16.0, was applied sequentially for traditional meta-analysis, subgroup analysis, and publication bias analysis.

Results

A total of nine papers were included. The total literature effect [SMD = −0.55, 95% CI = −0.76 to −0.35, Z = 5.38 (P &lt; 0.001)] indicated that physical activity had a significant effect on alleviating anxiety. Subgroup analysis also showed that exercise interventions using aerobic exercise or yoga were effective in relieving anxiety (SMD = −0.39, 95% CI = −0.74 to −0.04; SMD = −0.76, 95% CI = −1.14 to −0.39).

Conclusion

Physical activity interventions were shown to have a positive effect on alleviating anxiety in college students. Aerobic exercise was found to be the optimal mode.

Efficacy of B-vitamins and vitamin D therapy in improving depressive and anxiety disorders: a systematic review of randomized controlled trials

OBJECTIVES

This systematic review aimed to evaluate the efficacy of B vitamins and vitamin D therapy in improving the standard treatment of depression and anxiety disorders. We also aimed to gather the evidence supporting the recommendations for supplementation in clinical practice.

METHODS

Performed between March 2020 and September 2021, the main inclusion criteria were randomized controlled trials (RCTs), with patients ≥ 18 years old, both sexes, fulfilling target diagnoses of major depressive disorder (MDD), generalized anxiety disorder (GAD), or mild to severe depressive and anxiety symptoms. In addition, the RCTs were included if the scales to assess the severity of the symptoms were standardized rating scales in psychiatric. Trials that reported diagnoses of schizophrenia, perinatal depression, bipolar depression, sleep disorders, eating disorders, cancer, and multiple sclerosis in association with any of the mentioned diagnoses were excluded.

RESULTS

We identified 20 RCTs that matched all eligibility criteria, totaling 2,256 subjects, diagnosed with MDD, GAD, and depressive or anxiety symptoms. Supplementation with folic acid or L-methylfolate, B1, B12 or methylcobalamin, and vitamin D (in different doses and study duration) significantly decreased depression score scales by increasing response to standard pharmacological treatment or as monotherapy, including partial or complete remission. As for anxiety symptoms, the availability of results is limited to adjuvant vitamin D therapy.

DISCUSSION

B vitamins and vitamin D associated with other compounds also showed significant results, so the improvement in symptoms cannot be attributed strictly to those. Our results suggest that intervention with B vitamins and/or vitamin D may be an effective and well-tolerated adjuvant strategy for improving the symptoms of depression and anxiety, according to the patient's clinical status and nutritional biomarkers.

The Effect of Healthy Lifestyle Changes on Work Ability and Mental Health Symptoms: A Randomized Controlled Trial

OBJECTIVE

The effects of lifestyle interventions on the prevention of a decline in work ability and mental health are not well known. The aim of this randomized controlled trial was to examine the effects of healthy lifestyle changes on work ability, sleep, and mental health.

METHODS

Workers aged 18-65 years, who were free from cardiovascular diseases, diabetes, and malignant diseases, and did not use medication for obesity or lipids were included (N = 319). Based on their cholesterol balance, participants were classified into medium-risk and high-risk groups and were randomized into four arms: group lifestyle coaching (N = 107), individual lifestyle coaching (N = 53), the control group for group coaching (N = 106), and the control group for individual coaching (N = 53). The intervention groups received eight sessions of mostly remote coaching for 8 weeks about healthy diet, physical activity, other lifestyle habits, and sources/management of stress and sleep problems, and the control groups received no intervention. In individual coaching, the coach focused more on individual problem solving and the possibilities for motivation and change. The intention-to-treat principle was applied, and missing data on the outcomes were imputed using multiple imputation.

RESULTS

After the completion of the intervention, the risk of depressive symptoms was lower by 53% (95% CI 1-77%) in participants who received individual lifestyle coaching compared with the control group. The intervention had no beneficial effects on anxiety, work ability, sleep duration, or daily stress. In subgroup analyses, group lifestyle coaching had beneficial effects on depressive symptoms and work ability in participants with less tight schedules or less stretching work, whereas individual lifestyle coaching lowered the risk of depressive symptoms in those with fewer overlapping jobs, less tight schedules, or less stretching work.

CONCLUSION

Short but intensive remote lifestyle coaching can reduce depressive symptoms and improve work ability, and time-related resources at work may improve mental health in the context of individual lifestyle intervention. However, further randomized controlled trials are needed to confirm the findings.

The association between sedentary behavior and low back pain in adults: a systematic review and meta-analysis of longitudinal studies

Background

Low back pain (LBP) is a common musculoskeletal problem globally. While spending a longer time in sedentary behaviors is linked to several health problems; the quantitative association between different amounts of sedentary time and LBP is still unknown. This study aims to systematically review studies that examined the association between sedentary behavior and LBP development and LBP-related outcomes.

Methods

This systematic review and meta-analysis retrieved journal articles published from inception to March 2020 and were obtained by searching bibliographical databases. We included longitudinal study designs, including adult (aged ≥18) individuals with nonspecific LBP, and reporting estimates of the association between sedentary behavior and LBP development and LBP-related outcomes (i.e., pain intensity and disability).

Results

Sixteen longitudinal studies with 100,002 participants were included in this review (eight studies included in quantitative syntheses with 83,111 participants). The results of meta-analyses showed that a sedentary time of 3-<6 (Odds ratio (OR) 0.95, 95% CI [0.85-1.07]), 6-8 (OR 0.95, 95% CI [0.88-1.02]), and >8 (OR 0.92, 95% CI [0.85-1.00]) hours per day (h/d) was not associated with LBP development. A sedentary time of ≥3 h/d was associated with poor LBP-related disability (OR 1.24, 95% CI [1.02-1.51]), but not with pain intensity.

Conclusion

A meta-analyses of longitudinal studies indicated that sedentary behavior of different durations was not associated with LBP development. However, the results showed that sedentary behavior ≥3 h/d was associated with worse LBP-related disability. These conclusions are tentative as the evidence was derived from mostly fair-quality studies using subjective measures of sedentary behavior.

Systematic review registration

PROSPERO (registration number CRD42018107078).

Correlation between Physical Activity and Psychological Distress in Patients Receiving Hemodialysis with Comorbidities: A Cross-Sectional Study

Comorbidities cause psychological distress to patients on hemodialysis and cause their physical function to deteriorate. This study aims to examine whether physical patterns are associated with anxiety, depression and fatigue among patients with and without comorbidities who are on hemodialysis. To this end, a cross-sectional survey was administered to 120 patients on hemodialysis. Data were collected using the International Physical Activity Questionnaire—Short Form, Beck Depression Inventory—Second Edition, Beck Anxiety Inventory, and Brief Fatigue Inventory—Taiwan Version. An independent sample t test and generalized linear model analyses were conducted. The results revealed that patients with comorbidities exhibited more severe levels of depression (p < 0.001), anxiety (p < 0.001), and fatigue (p = 0.010) than patients without comorbidities. Additionally, patients on hemodialysis with a high physical activity level (≥600 metabolic equivalent of task per min/week) exhibited less depression (B = −4.03; p < 0.001; 95% confidence interval [CI] = −6.04, −2.03) and anxiety (B = −2.64; p = 0.002; 95% CI = −4.27, −1.00) severity than those with a low physical activity level; those who engaged in weekly physical activities exhibited less fatigue severity (B = −1.17; p = 0.001; 95% CI = −1.84, −0.49) and fatigue interference (B = −0.61; p = 0.015; 95% CI = −1.10, −0.12). For patients on hemodialysis, having comorbidities was correlated with more severe levels of depression, anxiety, and fatigue. Weekly moderate-intensity physical activities were revealed to be correlated with less severity levels of depression, anxiety, and fatigue. The study findings aid the development of interventions for promoting physical activity among patients on hemodialysis to prevent the exacerbation of complications caused by comorbidities and psychological distress.

State Anxiety after Exergame Beach Volleyball Did Not Differ between the Single and Multiplayer Modes in Adult Men

This study compared the exergame beach volleyball’s acute effects on state anxiety level in single vs. multiplayer mode in adult men. Sixty adult men (age: 21.98 [4.58] years, body mass: 75.40 [15.70] kg, height: 1.77 [0.09] m, and body mass index: 24.19 [5.44] kg/m²; data are expressed as median [interquartile range]) were assigned to play exergame of beach volleyball in single- or multiplayer mode for approximately 30 min using the Xbox 360 Kinect^®. The state anxiety level was evaluated before and after the intervention. There was no significant difference in the state anxiety levels after an exergame session between the single and multiplayer modes (p-value = 0.407, effect size (r_B) = −0.12, defined as small). Furthermore, there was no significant difference in the state anxiety levels before and after an exergame session in single-player mode (p-value = 0.516, effect size (d) = 0.14, defined as trivial) and multiplayer mode (p-value = 0.053, r_B = 0.43, defined as medium). In conclusion, state anxiety level after exergame beach volleyball did not differ between the single and multiplayer modes in adult men.

Prospective COVID-19 related changes in physical activity and sedentary time and associations with symptoms of depression and anxiety

PROBLEM

The COVID-19 pandemic is associated with psychological distress. Decreased moderate-vigorous physical activity (MVPA) and increased sedentary time may be exacerbating pandemic-related symptoms of anxiety and depression, but existing studies exploring these associations are almost entirely cross-sectional.

METHODS

Reported data from 2018 and Summer 2020 were used to create change categories based on compliance with MVPA guidelines and relative sedentary time. Participants completed the Patient Health Questionnaire-4 (PHQ-4) in Summer 2020. Associations among changes in MVPA and sedentary time (separately and jointly) with psychological distress (total PHQ-4 score) were examined with ordinal logistic regression and associations with depressive or anxiety symptoms were examined with logistic regression.

RESULTS

Among 2,240 participants (65% women, mean age 57.5 years), 67% increased sedentary time and 21% became inactive between the two time points. After multivariate adjustment, participants who became (OR = 1.71, 95% CI: 1.05-2.78) or remained inactive (OR = 2.07, 1.34-3.22) were more likely to experience depressive symptoms compared to those who remained active. Participants who increased sedentary time were also more likely to experience depressive symptoms compared to those who maintained sedentary time (OR = 1.78, 1.13-2.81). Jointly, those who increased sedentary time while remaining (OR = 3.67, 1.83-7.38) or becoming inactive (OR = 3.02, 1.44-6.34) were much more likely to have depressive symptoms compared to the joint referent (remained active/maintained sedentary time). Associations with anxiety symptoms were not statistically significant.

CONCLUSIONS

These findings support the value of promoting MVPA and limiting sedentary time during stressful events associated with psychological distress, like the COVID-19 pandemic.

The mediating and moderating effects of depressive symptoms on the prospective association between cognitive function and activities of daily living disability in older adults

OBJECTIVES

This study aimed to examine to what extent depressive symptoms mediated and moderated the association between cognitive function and activities of daily living (ADL) disability in older adults.

METHODS

In older participants from the China Health and Longitudinal Retirement Survey (CHARLS), structural equation modeling and multiple regression were performed to examine the mediating and moderating role of depressive symptoms (measured by the 10-item Center for Epidemiologic Studies Depression Scale) in the association between baseline cognitive function (episodic memory, attention, orientation to time, and visuospatial ability) and endpoint disability in basic ADL (BADL) or instrumental ADL (IADL).

RESULTS

Over a 2-year follow-up, among 1677 participants (67.5 ± 6.0 years old) free of BADL disability and 1194 participants (66.9 ± 5.6 years old) free of IADL disability, 8.3% and 22.9% developed BADL disability and IADL disability, respectively. Good baseline cognitive performance was significantly associated with the reduced incidence of BADL/IADL disability. The indirect effects of baseline depressive symptoms explained 16.9% and 14.5% of the total effect between cognition and BADL and IADL dependency, respectively. The Johnson-Neyman technique identified a threshold of 7.88 for endpoint depressive symptoms, beyond which the protective effect of baseline cognitive function on BADL emerged.

CONCLUSIONS

In older adults, good cognitive function reduces the risk of BADL/IADL disability. Depressive symptoms downregulate the protective effect of cognitive function on BADL/IADL over time. Intervention techniques focusing on the simultaneous improvement of cognitive dimensions and depression help improve ADL difficulty and prevent disability in older adults.

Acupuncture for the Treatment of Depression and Physical Symptoms in Chronic Bipolar Disorder: A Case Report

Introduction

Bipolar disorder (BD) is typically treated by pharmacotherapy. However, pharmacotherapy alone is often not adequate to cope with the variety of symptoms associated with BD. The present case report describes the therapeutic effects of manual acupuncture on a patient with chronic BD, and multiple concurrent physical symptoms, that did not improve with standard pharmacotherapy.

Case

A 41-year-old woman with type II BD presented with depression, anxiety, and multiple physical symptoms. Her symptoms had first appeared 12 years prior, and she was diagnosed with type II BD 3 years after symptom onset. Although she received standard treatment, including medication and psychotherapy, her symptoms did not improve. Acupuncture treatment aimed at improving psychiatric and physical symptoms was performed weekly for 12 weeks. Depression and anxiety symptoms were evaluated using the Himorogi Self-Rating Depression Scale (HSDS) and Himorogi Self-Rating Anxiety Scale (HSAS) respectively. A visual analog scale (VAS) was used to evaluate physical symptoms including diarrhea, insomnia, and general malaise. Outcome measures were evaluated before each treatment.

Results

Throughout the course of the acupuncture intervention, no changes were made to the patient's psychotropic medication regimen. HSDS and HSAS scores decreased after 12 weeks of acupuncture treatment and improvements in all physical symptoms, as measured by the VAS, were observed. Furthermore, psychiatric symptoms with hypomanic or mixed features were not exacerbated.

Conclusions

In this patient, acupuncture was effective in improving psychiatric and physical symptoms of type II BD. This non-pharmacological intervention may be a viable option for the treatment of BD-associated symptoms.

Physical Activity of Secondary School Adolescents at Risk of Depressive Symptoms

BACKGROUND

The aim of the study is to analyze the associations between depressive symptoms (DS), well-being and different types of physical activity (PA) in adolescents.

METHODS

Overall, 368 girls and 228 boys aged 15-19 years were involved in the research. To explore the composition of weekly PA, we used the IPAQ-Long questionnaire, and a pedometer was used to monitor weekly PA. The prevalence of DS was diagnosed by the Bern Subjective Well-Being Questionnaire and the WHO-5 Well-Being Index.

RESULTS

The girls and boys who reported the most DS and the lowest level of well-being had significantly less weekly recreational PA. The girls who reported the fewest DS had a 2.12 times greater odds of meeting the 11,000 steps/day recommendation than did the girls with the most DS, whereas we did not detect statistically significant differences in rates of meeting the recommendation in the boys with distinct levels of DS.

CONCLUSIONS

The study confirms the stronger negative associations between DS and PA, especially among girls. The greatest opportunities for behavioral change in adolescents at the highest risk of DS are in the promotion of recreational PA.

Lifestyle and biological factors influence the relationship between mental health and low-grade inflammation

Mental health modulates the risk of common chronic conditions. Although inflammation is thought to partly explain this link, its relation with mental health is still unclear and largely unexplored. We investigated three scales assessing psychological resilience (CD-RISC), depression symptoms (PHQ9-6) and mental wellbeing (SF36-MCS) in an Italian adult population cohort (N_max = 16,952). This showed a slightly higher frequency of men, more educated and younger participants, compared to samples with incomplete questionnaires. We performed stepwise generalized linear models to test the association between each scale and INFLA-score, a composite blood-based inflammation index. At each step, a class of potential mediators was included in the model, namely health conditions, lifestyle factors, or both (full model). Full model analysis was also conducted on single blood markers involved in the inflammatory process. In the baseline model, we observed significant associations of PHQ9-6 (standardized β(SE) = 0.024(0.009), p = 8.9 × 10^-3) and SF36-MCS (β(SE) = -0.021(0.008), p = 7 × 10^-3) with INFLA-score. These associations survived adjustment for health conditions but not for lifestyle factors, which explained 81% and 17% of the association with PHQ9-6 and SF36-MCS. Significant associations (p < 4.2 × 10^-3) after mediator adjustment were observed for single low-grade inflammation markers, including platelet distribution width (with PHQ9-6 and CD-RISC), granulocyte- and neutrophil-to-lymphocyte ratios, monocyte and lymphocyte fractions (with SF36-MCS). After imputation of missing data, we observed substantially consistent associations. These findings suggest that the relationship between mental health and low-grade inflammation is largely influenced by lifestyle. However, the associations with specific biomarkers related to inflammation are partly independent and might be explained by biological factors.

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

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

Clinical and Cost-Effectiveness of Personalized Tele-Based Coaching for Farmers, Foresters and Gardeners to Prevent Depression: Study Protocol of an 18-Month Follow-Up Pragmatic Randomized Controlled Trial (TEC-A)

Background: Farmers show high levels of depressive symptoms and mental health problems in various studies. This study is part of a nationwide prevention project carried out by a German social insurance company for farmers, foresters, and gardeners (SVLFG) to implement internet- and tele-based services among others to improve mental health in this population. The aim of the present study is to evaluate the (cost-)effectiveness of personalized tele-based coaching for reducing depressive symptom severity and preventing the onset of clinical depression, compared to enhanced treatment as usual. Methods: In a two-armed, pragmatic randomized controlled trial (N = 312) with follow-ups at post-treatment (6 months), 12 and 18 months, insured farmers, foresters, and gardeners, collaborating family members and pensioners with elevated depressive symptoms (PHQ-9 ≥ 5) will be randomly allocated to personalized tele-based coaching or enhanced treatment as usual. The coaching is provided by psychologists and consists of up to 34 tele-based sessions for 25-50 min delivered over 6 months. Primary outcome is depressive symptom severity at post-treatment. Secondary outcomes include depression onset, anxiety, stress, and quality of life. A health-economic evaluation will be conducted from a societal perspective. Discussion: This study is the first pragmatic randomized controlled trial evaluating the (cost-)effectiveness of a nationwide tele-based preventive service for farmers. If proven effective, the implementation of personalized tele-based coaching has the potential to reduce disease burden and health care costs both at an individual and societal level. Clinical Trial Registration: German Clinical Trial Registration: DRKS00015655.

Levels of Physical Activity, Obesity and Related Factors in Young Adults Aged 18-30 during 2009-2017

The objective of this study was to analyze the temporal trend of physical activity and body mass index in young adults aged 18–30 in Spain and to ascertain their relationship with sociodemographic and psychosocial variables in the period of 2009–2017. Methods: A descriptive study with a sample of 10,061 young adults aged 18–30 years was performed. The data were obtained from the European Health Survey in Spain in 2009 and 2014 and the National Health Survey in 2011/2012 and 2017. The chi-square test was used for qualitative variables, and multiple linear regression analysis was performed for physical activity. Results: Sedentary levels had decreased in 2017 as compared to 2011/2012 (p < 0.001); smokers were more sedentary than non-smokers (p < 0.001); men were more active than women (p < 0.001); and the year with the highest physical activity was 2014. Body mass index in the total sample increased from 2009 to 2017 (p < 0.01), showing a significant increase in obesity in women (p < 0.05) and no difference in men (p ≥ 0.05). Conclusions: In the period 2011/2012–2017, the sedentary lifestyle of young adults was reduced and physical activity was increased, with men being more active than women.

Leisure time physical activity reduces the association between TV-viewing and depressive symptoms: A large study among 59,401 Brazilian adults

BACKGROUND

Both physical activity (PA) and TV-viewing are associated with depressive symptoms, but the combined association with depressive symptoms is unclear. Therefore, our aim was to analyze the joint association of PA and TV-viewing with depressive symptoms among a large cohort of adults.

METHODS

We used data from the Brazilian National Survey, conducted in 2013 with 59,401 adults [≥18 years (34,282 women)]. Information regarding exposures (TV-viewing and leisure PA), outcome (depressive symptoms) and covariates (chronological age, race, educational status, employment status, tobacco smoking, alcohol consumption) were self-reported. Body mass index was estimated through the assessment of body mass and stature. Logistic regression models were used.

RESULTS

Engaging in >5 hours of TV viewing was associated with elevated depressive symptoms [13.1% (CI95%: 11.6%-14.7%) vs. 7.4% (95%CI:7.0%-7.8%)]. However, this association was nullified when people met guidelines and engaged in >150 min of PA per week. Specifically, among men [Active: OR = 1.16 (95%CI: 0.58-2.32) vs. Inactive: OR = 3.63 (95%CI: 2.43-5.42)] and women [Active: OR=1.30 (95%CI: 0.80-2.11) vs. Inactive: OR = 1.84 (95%CI: 1.43-2.36)].

CONCLUSION

Whilst TV viewing is associated with increased depressive symptoms, meeting recommended physical activity levels reduces the association between TV-viewing and depressive symptoms.

Experimental Evaluation of the Joint Effects of Exercise and Sedentary Behavior on Cognitive Function

Background

The objective of this study was to evaluate the potential joint effects of sedentary behavior and exercise on cognitive function.

Methods

Participants (M_age = 20 yrs) were randomly assigned to one of three experimental groups. The No Exercise Group (n = 19) was instructed to reduce steps to less than 5000/day and were not allowed to exercise for one-week; the Reduced MVPA (moderate-to-vigorous PA) Group (n = 18) was instructed to reduce steps to less than 5000/day but exercised for 50% of their previously reported vigorous PA for one-week; and the Control Group (n = 20) maintained normal activity for one-week. Cognitive functions (via Stroop and Trail Making tasks) were assessed at baseline, post-intervention, and after one week of resumed normal activity for the intervention groups.

Results

Statistically significant main effects for time were observed for Stroop Congruent (F_time = 11.7, p < 0.001, η ² _p = 0.18), Stroop Incongruent (F_time = 19.4, p < 0.001, η ² _p = 0.26), Stroop Control (F_time = 54.4, p > 0.001, η ² _p = 0.50), Trail Making-A (F_time = 19.1, p < 0.001, η ² _p = 0.26) and Trail Making-B (F_time = 13.8, p < 0.001, η ² _p = 0.21) tasks. However, there were no statistically significant group x time interactions (all p's > 0.05) for any of the cognitive parameters.

Conclusion

These experimental findings do not suggest an interaction effect between sedentary behavior and physical activity on cognitive function.