Gender, mental health service use and objectively measured physical activity: Data from the National Health and Nutrition Examination Survey (NHANES 2003-2004)

Substitutions of physical activity, sedentary behaviour and sleep: associations with mental health in middle-aged and elderly persons

Background

Physical activity, sedentary behaviour and sleep are potential risk factors of mental health disorders, but previous studies have not considered the dependency between these activity domains. Therefore, we examined the associations of reallocations of time among older adults’ physical activity, sedentary behaviour and sleep with depressive and anxiety symptoms using compositional isotemporal substitution analyses.

Methods

We included 1943 participants (mean age 71 years, SD: 9; 52% women) from the population-based Rotterdam Study. Between 2011 and 2016, we collected accelerometer data (mean duration 5.8 days, SD: 0.4) on physical activity, sedentary behaviour and sleep and self-reported data on depressive symptoms and anxiety.

Results

A reallocation of 30 min more moderate-to-vigorous physical activity was associated with a −0.55 (95% CI −1.04 to −0.06) points lower depressive symptoms score when replacing sleep and a −0.59 (95% CI −1.06 to −0.12) points lower score when replacing sedentary behaviour, but not when replacing light physical activity (−0.70, 95% CI −1.63 to 0.24). No associations were found for anxiety.

Conclusion

Replacing sedentary behaviour or sleep with more moderate-to-vigorous physical activity was associated with less depressive symptoms, suggesting that mainly intensive types of physical activity are important for middle-aged and older adults in relation to depressive symptoms.

Moving Towards Wellness: Physical activity practices, perspectives, and preferences of users of outpatient mental health service

OBJECTIVE

This study assessed the beliefs, barriers and preferences for physical activity (PA) among users of outpatient mental health (MH) services. Outpatient discussions with MH providers were also evaluated.

METHOD

Between September-December 2014, patient advisors approached adult and family members in an academic MH clinic's waiting room on high volume patient visit days during peak clinic hours; 83% participated in the survey. Analyses were restricted to MH services users (n=295).

RESULTS

Fully 84% of respondents reported a link between PA and their mood or anxiety level and 85% wanted to be more active. Less than half currently met US PA guidelines (≥150min/week). Most (52%) reported their mood limited their involvement in PA. Only 37% reported their MH providers regularly discussed PA with them. Beliefs about the benefits of physical activity (p<0.0001), mood limiting their ability to be physically active (p=0.03), and wanting to be more physically active (p=0.02) were significant predictors of PA (min/week) in the multivariate linear regression model.

CONCLUSIONS

Most MH outpatients may need and want assistance in increasing PA. Patient-centered research could inform the development of PA programs in MH settings.

Accelerometer-measured sedentary behaviour and physical activity of inpatients with severe mental illness

Sedentary behaviour and lack of physical activity threatens health. Research concerning these behaviours of inpatients with severe mental illness is limited but urgently needed to reveal prevalence and magnitude. In total, 184 inpatients (men n =108, women n =76, mean age 57,4, 20% first generation antipsychotics, 40% second generation antipsychotics, 43% antidepressants, mean years hospitalisation 13 years), with severe mental illness of a Dutch psychiatric hospital wore an accelerometer for five days to objectively measure total activity counts per hour and percentages in sedentary behaviour, light intensity physical activity and moderate to vigorous physical activity. Accelerometer data were compared with data of 54 healthy ward employees. Patients showed significantly less activity counts per hour compared to employees (p=0.02), although the differences were small (d=0.32). Patients were sedentary during 84% of the wear time (50min/h), spend 10% in light intensity physical activity and 6% in moderate to vigorous physical activity. Age was the only significant predictor, predicting less total activity counts/h in higher ages. Decreasing sedentary behaviour and improving physical activity in this population should be a high priority in clinical practice.

Promoting Nature-Based Activity for People With Mental Illness Through the US "Exercise Is Medicine" Initiative

Nature-based physical activity programming (e.g., countryside walks, hiking, horseback riding) has been found to be an effective way to help improve the health of people with mental illness. Exercise referral initiatives, whereby health practitioners prescribe exercise in an attempt to prevent or treat chronic illnesses, have helped make such nature-based activities accessible to this population in the United Kingdom and Australia; however, there is a dearth of research related to the most prominent exercise referral program in the United States: Exercise is Medicine. Taking into account the barriers to physical activity faced by people with mental illness, we explore how nature-based programming for this population might be mobilized in the United States through the growing Exercise is Medicine initiative.

Physical activity improves mental health through resilience in Hong Kong Chinese adolescents

Background

Adolescent mental health problems are global public health concern. Primary prevention through physical activity (PA) has been suggested as a potential approach to tackling this problem. Studies in Western countries have provided some evidence of a relationship between PA and adolescent mental health, but the evidence in China is not sufficient. Furthermore, the mechanism behind this relationship has not been empirically tested. The present study aimed at testing the association between PA and mental well-being of Chinese adolescents and to investigate whether a psychological (self-efficacy and resilience) and social (school and family connectedness) mediation model is valid to explain such a relationship.

Methods

A total of 775 Chinese students in Grades 7 and 8 were recruited in this cross-sectional study. The participants were given questionnaires to assess their PA level, mental well-being, and the potential mediators. Path models were used to analyse the association between PA and mental well-being, and the roles of potential mediators.

Results

The PA level was significantly correlated with the adolescent’s mental well-being (r = 0.66, p < 0.001), self-efficacy (r = 0.21, p < 0.001), and resilience (r = 0.25, p < 0.001), but not with school connectedness (r = 0.05, p = 0.15) or family connectedness (r = 0.06, p = 0.13). After adjusting for potential confounders in the path model, the PA level was significantly associated with mental well-being (b = 0.52, p < 0.001), and resilience was the only significant mediator (b = 0.31, p < 0.001), which contributed to 60% of this relationship.

Conclusions

There was a significant positive association between the PA level and mental well-being of Chinese adolescents. Resilience mediated the majority of this relationship. Promoting physical activities that build up resilience could be a promising way to improve adolescent mental health.

Selection, use and psychometric properties of physical activity measures to assess individuals with severe mental illness: a narrative synthesis

This research provides a critical consideration of the outcome measures used to assess physical activity in individuals with severe mental illness. A narrative synthesis was utilised to provide a simple juxtapose of the current research. A sensitive topic-based search strategy was conducted in order to identify studies that met the eligibility criteria. Fifty two studies met the inclusion criteria and 5 were identified specially as validation studies. The current research identified several methodological shortcomings. The justification and choice of outcome measure used is often weak and only five studies have validated a specific outcome measure of physical activity. Within these validation studies, the validation process often lacked a consideration of agreement between measures. Accelerometers have been most frequently used as a criterion measure, notably the RT3 tri-axial accelerometer. Objective based measures may be best placed to consider physical activity levels, although, methodological considerations for the utilization of such tools is required. Self-report questionnaires have benefits for use in this population but require further validation. Researchers and clinicians need to carefully consider what outcome measure they are using and be aware of the development, scope and purpose of that measure.

Associations between objectively assessed and self-reported sedentary time with mental health in adults: an analysis of data from the Health Survey for England

OBJECTIVE

There is increasing interest in the association between sedentary behaviour and mental health, although most studies have relied solely on self-reported measures, thus making results prone to various biases. The aim was to compare associations between objectively assessed and self-reported sedentary time with mental health in adults.

SETTING

Community dwelling population sample drawn from the 2008 Health Survey for England.

PARTICIPANTS

11 658 (self-report analysis) and 1947 (objective data) men and women.

PRIMARY OUTCOME

The 12-item General Health Questionnaire was administered to assess psychological distress. Sedentary and physical activity (exposure) was objectively measured using accelerometers (Actigraph GT1M) worn around the waist during waking hours for seven consecutive days.

RESULTS

The highest tertile of objective sedentary time was associated with higher risk of psychological distress (multivariate adjusted OR=1.74, 95% CI 1.07 to 2.83), as was the highest tertile of self-reported total sitting time (OR=1.34, 95% CI 1.15 to 1.56). Self-reported, but not objective, moderate-to-vigorous physical activity was associated with lower risk of psychological distress. Only objective light-intensity activity was associated with lower risk of psychological distress.

CONCLUSIONS

Sedentary time is associated with adverse mental health.

Changes in prevalence of depression and anxiety following smoking cessation: results from an international cohort study (ATTEMPT)

BACKGROUND

Smoking cessation improves physical health but it has been suggested that in vulnerable individuals it may worsen mental health. This study aimed to identify the short- and longer-term effects of stopping smoking on depression and anxiety in the general population and in those with a history of these disorders.

METHOD

Sociodemographic and smoking characteristics, and mental and physical health were assessed using established measures in the ATTEMPT cohort, an international longitudinal study of smokers (n = 3645). Smokers who had stopped for at least 3 months or less than 3 months at the 12-month follow-up were compared with current smokers (n = 1640).

RESULTS

At follow-up, 9.7% [95% confidence interval (CI) 8.3-11.2] of smokers had stopped for less than 3 months and 7.5% (95% CI 6.3-8.9) for at least 3 months. Compared with current smokers, prevalence of depression prescriptions obtained in the last 2 weeks was lower for those who had stopped for less than 3 months [odds ratio (OR) 0.37, 95% CI 0.14-0.96] or at least 3 months (OR 0.25, 95% CI 0.06-0.94) after adjusting for baseline prescription levels and confounding variables. Adjusted prevalence of recent depression symptoms was also lower for ex-smokers who had stopped for less than 3 months (OR 0.34, 95% CI 0.15-0.78) or at least 3 months (OR 0.24, 95% CI 0.09-0.67) than among continuing smokers. There was no change in anxiety measures in the general population or any increase in anxiety or depression symptoms in ex-smokers with a past history of these conditions.

CONCLUSIONS

Smoking cessation does not appear to be associated with an increase in anxiety or depression and may lead to a reduced incidence of depression.

Are adults with bipolar disorder active? Objectively measured physical activity and sedentary behavior using accelerometry

BACKGROUND

Little is known about physical activity and sedentary behavior of adults with bipolar disorder (BP). Physical activity and sedentary behaviors may be modifiable factors associated with elevated rates of obesity, diabetes, cardiovascular disease, metabolic syndrome, and mortality in adults with BP.

METHODS

Sixty adult outpatients treated for BP (> 18 yr) wore accelerometers for seven consecutive days. Each minute epoch was assigned an activity level based on the number of counts per minute; sedentary(<100 counts), light(101-1951 counts), or moderate/vigorous(>1952 counts). Adults with BP were matched 1:1 to users and non-users of mental health services (MHS) (NHANES 2003-2004) by gender, closest BMI, and age.

RESULTS

On average, adults with BP wore actigraphs over 17 h/day. The majority of monitoring time (78%) was classified as sedentary (approximately 13.5h/day). Light physical activity accounted for 21% of the monitoring time/day (215 min/day). None achieved 150 min/wk of moderate/vigorous activity as recommended by national guidelines. Adults with BP were significantly less active and more sedentary than MHS users and non-users in NHANES 2003-2004 (p<0.01).

LIMITATIONS

Majority of the participants were relatively asymptomatic with most (87%) having no more than mild depressive symptoms and none experiencing severe manic symptoms. The sedating effects of medications on physical activity were not investigated.

CONCLUSION

From clinical perspectives, these findings justify physical activity interventions targeting adults with BP as a possible means to improve their physical and mental health and to reduce the elevated risk of commonly observed medical comorbidities in this high-risk population.

Sedentary behavior and psychiatric symptoms in overweight and obese adults with schizophrenia and schizoaffective disorders (WAIST Study)

OBJECTIVE

Examine the association between sedentary behavior and psychiatric symptoms among overweight and obese adults with schizophrenia or schizoaffective disorders (SZO/SA).

DESIGN

Randomized clinical trial; Weight Assessment and Intervention in Schizophrenia Treatment (WAIST) Study: baseline data collected 2005-2008.

SETTING

University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

PARTICIPANTS

Community-dwelling adults diagnosed with SZO/SA, with mild symptom severity [Positive and Negative Syndrome Scale (PANSS)<90], who were interested in losing weight, age 18-70years, BMI>27kg/m(2).

MEASUREMENTS

Objectively measured sedentary behavior by accelerometry, and psychopathology assessed by PANSS. Participants wore the actigraphs for 7 consecutive days during their waking hours. Sedentary behavior was defined as ≤100 counts per minute during wear-time and excluded sleep and non-wear time.

RESULTS

On average, 81% of the participant's monitoring time or 756min/day was classified as sedentary behavior using accelerometry. No association was observed between sedentary behaviors and PANSS psychiatric symptoms [total (p≥0.75), positive (p≥0.81), negative (p≥0.59) and general psychopathology (p≥0.65) subscales]. No association was observed between sedentary behaviors and age, race, gender and BMI.

CONCLUSION

From a clinical and public health perspective, the amount of time (approximately 13h) and percentage of time (81% excluding non-wear time associated with sleeping) engaged in sedentary behavior among overweight and obese adults in this population is alarming, and points to an urgent need for interventions to decrease sedentary behaviors. The lack of associations between sedentary behavior and psychiatric symptoms may be due to a ceiling effect for sedentary behavior.

Psychosocial stress and cardiovascular disease risk: the role of physical activity

Chronic stress and depression are associated with increased risk of cardiovascular disease and poorer prognosis, and physical (in)activity may be a key underlying biobehavioral mechanism. Physical activity has antidepressant effects, and physically fitter, more active individuals seem to be more biologically resilient to psychosocial stressors. This article will present data from a series of population cohort studies and laboratory-based psychophysiological studies to explore the role of physical activity as a protective factor against the effects of psychosocial stress on cardiovascular disease. These mechanisms may improve the treatment and prevention of stress-related illnesses and, thus, has important implications for public health and clinical care of high-risk patients.

A catalog of rules, variables, and definitions applied to accelerometer data in the National Health and Nutrition Examination Survey, 2003-2006

Introduction

The National Health and Nutrition Examination Survey (NHANES) included accelerometry in the 2003–2006 data collection cycles. Researchers have used these data since their release in 2007, but the data have not been consistently treated, examined, or reported. The objective of this study was to aggregate data from studies using NHANES accelerometry data and to catalogue study decision rules, derived variables, and cut point definitions to facilitate a more uniform approach to these data.

Methods

We conducted a PubMed search of English-language articles published (or indicated as forthcoming) from January 2007 through December 2011. Our initial search yielded 74 articles, plus 1 article that was not indexed in PubMed. After excluding 21 articles, we extracted and tabulated details on 54 studies to permit comparison among studies.

Results

The 54 articles represented various descriptive, methodological, and inferential analyses. Although some decision rules for treating data (eg, criteria for minimal wear-time) were consistently applied, cut point definitions used for accelerometer-derived variables (eg, time spent in various intensities of physical activity) were especially diverse.

Conclusion

Unique research questions may require equally unique analytical approaches; some inconsistency in approaches must be tolerated if scientific discovery is to be encouraged. This catalog provides a starting point for researchers to consider relevant and/or comparable accelerometer decision rules, derived variables, and cut point definitions for their own research questions.

Impact of treadmill exercise on efficacy expectations, physical activity, and stroke recovery

Stroke survivors are at high risk for cardiovascular mortality which can be in part mitigated by increasing physical activity. Self-efficacy for exercise is known to play a role in adoption of exercise behaviors. This study examines self-reported psychological outcomes in a group of 64 stroke survivors randomized to either a 6-month treadmill training program or a stretching program. Results indicated that, regardless of group, all study participants experienced increased self-efficacy (F = 2.95, p = .09) and outcome expectations for exercise (F = 13.23, p < 0.001) and improvements in activities of daily living as reported on the Stroke Impact Scale (F = 10.97, p = .002). No statistically significant between-group differences were noted, possibly because of the fact that specific interventions designed to enhance efficacy beliefs were not part of the study. Theoretically based interventions should be tested to clarify the role of motivation and potential influence on exercise and physical activity in the stroke survivor population.

Validation of activity questionnaires in patients with cystic fibrosis by accelerometry and cycle ergometry

BACKGROUND

The objective of this study was to validate physical activity questionnaires for cystic fibrosis (CF) against accelerometry and cycle ergometry.

METHODS

41 patients with CF (12-42 years) completed the Habitual Activity Estimation Scale (HAES), the 7-Day Physical Activity Recall questionnaire (7D-PAR) and the Lipid Research Clinics questionnaire (LRC) and performed an incremental exercise test according to the Godfrey protocol up to volitional fatigue. Time spent in moderate and vigorous physical activity (MVPA) assessed objectively by accelerometry was related to the time spent in the respective activity categories by correlation analyses and calculating intraclass correlation coefficients (ICC). Furthermore, the results of the exercise test were correlated with the results of the questionnaires.

RESULTS

Time spent in the categories 'hard','very hard' and 'hard & very hard' of the 7D-PAR (0.41 < r < 0.56) and 'active' (r = 0.33) of the HAES correlated significantly with MVPA. The activity levels of the LRC were not related to objectively determined physical activity. Significant ICCs were only observed between the 7D-PAR activitiy categories and MVPA (ICC = 0.40-0.44). Only the LRC showed moderate correlations with the exercise test (Wmax: r = 0.46, p = 0.002; VO2peak: r = 0.32, p = 0.041).

CONCLUSIONS

In conclusion, the activity categories 'hard' and 'very hard' of the 7D-PAR best reflected objectively measured MVPA. Since the association was at most moderate, the 7D-PAR may be selected to describe physical activity within a population. None of the evaluated questionnaires was able to generate valid physical activity data exercise performance data at the individual level. Neither did any of the questionnaires provide a valid assessment of aerobic fitness on an invidual level.

Use of accelerometry to measure physical activity in adults and the elderly

OBJECTIVE

To review the use of accelerometry as an objective measure of physical activity in adults and elderly people.

METHODS

A systematic review of studies on the use of accelerometty as an objective measure to assess physical activity in adults were examined in PubMed Central, Web of Knowledge, EBSCO and Medline databases from March 29 to April 15, 2010. The following keywords were used: "accelerometry," "accelerometer," "physical activity," "PA," "patterns," "levels," "adults," "older adults," and "elderly," either alone or in combination using "AND" or "OR." The reference lists of the articles retrieved were examined to capture any other potentially relevant article. Of 899 studies initially identified, only 18 were fully reviewed, and their outcome measures abstracted and analyzed.

RESULTS

Eleven studies were conducted in North America (United States), five in Europe, one in Africa (Cameroon) and one in Australia. Very few enrolled older people, and only one study reported the season or time of year when data was collected. The articles selected had different methods, analyses, and results, which prevented comparison between studies.

CONCLUSIONS

There is a need to standardize study methods for data reporting to allow comparisons of results across studies and monitor changes in populations. These data can help design more adequate strategies for monitoring and promotion of physical activity.

Physical activity in the post-hip-fracture period

The purpose of this study was to characterize physical activity (PA) based on survey and ActiGraphy data from older adults at 2 mo post-hip fracture and consider the factors that influence PA among these individuals. The sample included participants from a current Baltimore hip study, the BHS-7. Measurement of PA was based on the Yale PA Survey (YPAS) and 48 hr of ActiGraphy. The sample included the first 200 individuals enrolled in the study, with analyses including 117 individuals (59%) who completed the YPAS and wore the ActiGraph for 48 hr. Half the participants were male, with an overall mean age of 81.3 yr (SD = 7.9). Findings indicate that at 2 mo post-hip fracture participants were engaged in very limited levels of PA. Age and comorbidities were the only variables to be significantly associated with PA outcomes.

Physical activity, stress reduction, and mood: insight into immunological mechanisms

Psychosocial factors, such as chronic mental stress and mood, are recognized as an important predictor of longevity and wellbeing. In particular, depression is independently associated with cardiovascular disease and all-cause mortality, and is often comorbid with chronic diseases that can worsen their associated health outcomes. Regular exercise is thought to be associated with stress reduction and better mood, which may partly mediate associations between depression, stress, and health outcomes. The underlying mechanisms for the positive effects of exercise on wellbeing remain poorly understood. In this overview we examine epidemiological evidence for an association between physical activity and mental health. We then describe the exercise withdrawal paradigm as an experimental protocol to study mechanisms linking exercise, mood, and stress. In particular we will discuss the potential role of the inflammatory response as a central mechanism.

Depressive and anxiety disorders and the association with obesity, physical, and social activities

OBJECTIVE

There is evidence of more obesity among persons with depressive and depressive and anxiety disorders. However, the nature and the underlying mechanisms of the association are still unclear. This study examines the association between depressive and anxiety disorders and obesity, physical activity, and social activity, and examines whether social and physical activity are potential influencing factors in the association between depressive and anxiety disorders and obesity.

METHOD

Cross-sectional data were used from the Netherlands Study of Depression and Anxiety. A total of 1,854 women and 955 men aged 18-65 years were recruited from the community, general practices, and specialized mental health care. Depressive and anxiety disorders were determined with the Composite International Diagnostic Interview. Body mass index (BMI<30 kg/m(2) ) was used to determine obesity. Physical and social activities were measured by self-report.

RESULTS

The odds of obesity adjusted for covariates was significantly higher among those with a current pure Major Depressive Disorder (MDD;odds ratio [OR] OR:1.43; 95% CI:1.07-1.92) compared to controls. Physical activity and social activities were lower among persons with depressive and anxiety disorders compared to controls. The association between MDD and obesity was influenced by social and physical activities.

CONCLUSION

This study confirmed a link between depressive disorders and obesity that was influenced by lower social and physical activities among the depressed.

Plasma adiponectin concentration is associated with the average accelerometer daily steps counts in healthy elderly females

This study is aimed to evaluate whether circulating adiponectin concentration is associated with physical activity (PA) level in healthy older females. To date, daily PA in older adults (> or = 65 years) has primarily relied on self-report. This study used accelerometry, which objectively measured minute-by-minute movement to assess PA volume and intensity performed by elderly females. In addition, body composition, leptin and insulin resistance values were measured to assess the influence of these parameters on the possible relationship between adiponectin and PA levels in this specific age group of older women. On 49 women (mean age: 73.6 +/- 4.2 years), adiponectin, leptin, insulin resistance, body composition and 7-day PA parameters were measured. Average daily accelerometer step counts and time spent in different PA levels were obtained from 7-day PA measurement. Average daily accelerometer step-count was 7,722 +/- 3,069 steps day(-1) and the recommended 150 min weekly of at least moderate/vigorous PA in bouts of at least 10 min was achieved by 71.4% (35/49) of the participants. Correlation analysis showed that plasma adiponectin concentration (16.0 +/- 6.1 microg ml(-1) ) was related (P < 0.001) to steps per day (r = 0.438) and leptin (r = -0.443) values. Multivariate regression analysis further revealed that only steps per day and leptin were independent predictors of circulating adiponectin concentration in healthy elderly females. In conclusion, these data support the hypothesis that being physically active is associated with better adiponectin concentration and a reduced risk of having metabolic disease risk in the specific group of healthy elderly females.