Adherence to aerobic and muscle-strengthening exercise guidelines and associations with psychological distress: A cross-sectional study of 14,050 English adults

How many adults have sufficient muscle-strengthening exercise and the associated factors: A systematic review consisting of 2,629,508 participants

Purpose

The aim of this systematic review was to (1) estimate the prevalence of adhering to the MSE guidelines (at least 2 times/days a week) among adults; and (2) synthesize evidence on the correlates of adhering to the MSE guidelines.

Methods

Five electronic databases were searched (March 2022), with a total of 30 observational studies consisting of 2,629,508 participants meeting the eligibility criteria. A meta-analysis was conducted to pool the prevalence of adhering to the MSE guidelines using the results of 21 eligible studies (study aim 1); and data reporting correlates of adhering to the MSE guidelines using 12 eligible studies were synthesized and categorized based on the Socioecological Model Framework (study aim 2).

Results

Overall, 22.8 % (95%CI: 18.18 % ─ 27.77 %) of adults adhered to the MSE guidelines, and 23 potential correlates at five levels were examined. Five variables (i.e., sex, age, education level, socioeconomic status) at the sociodemographic level and two variables (i.e., body mass index, self-rated health) at the physical related level were identified as consistent correlates, but displaying weak to moderate association strengths.

Conclusions

Less than a quarter of adults meet the MSE guidelines and multidimensional correlates are associated with the adherence to the guidelines, particularly sociodemographic correlates (e.g., sex, age, and educational level). Findings highlight the need to further promote the importance of engaging in MSE among adults and investing effective interventions that not only provide opportunities for MSE for adults, but also facilitate the development of skills and confidence to engage in MSE.

Effect of Stress-Related Neural Pathways on the Cardiovascular Benefit of Physical Activity

BACKGROUND

The mechanisms underlying the psychological and cardiovascular disease (CVD) benefits of physical activity (PA) are not fully understood.

OBJECTIVES

This study tested whether PA: 1) attenuates stress-related neural activity, which is known to potentiate CVD and for its role in anxiety/depression; 2) decreases CVD in part through this neural effect; and 3) has a greater impact on CVD risk among individuals with depression.

METHODS

Participants from the Mass General Brigham Biobank who completed a PA survey were studied. A subset underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomographic imaging. Stress-related neural activity was measured as the ratio of resting amygdalar-to-cortical activity (AmygAC). CVD events were ascertained from electronic health records.

RESULTS

A total of 50,359 adults were included (median age 60 years [Q1-Q3: 45-70 years]; 40.1% male). Greater PA was associated with both lower AmygAC (standardized β: -0.245; 95% CI: -0.444 to -0.046; P = 0.016) and CVD events (HR: 0.802; 95% CI: 0.719-0.896; P < 0.001) in multivariable models. AmygAC reductions partially mediated PA's CVD benefit (OR: 0.96; 95% CI: 0.92-0.99; P < 0.05). Moreover, PA's benefit on incident CVD events was greater among those with (vs without) preexisting depression (HR: 0.860; 95% CI: 0.810-0.915; vs HR: 0.929; 95% CI: 0.910-0.949; P interaction = 0.011). Additionally, PA above guideline recommendations further reduced CVD events, but only among those with preexisting depression (P interaction = 0.023).

CONCLUSIONS

PA appears to reduce CVD risk in part by acting through the brain's stress-related activity; this may explain the novel observation that PA reduces CVD risk to a greater extent among individuals with depression.

Independent and Joint Associations of Physical Activity and Sleep on Mental Health Among a Global Sample of 200,743 Adults

BACKGROUND

Previous research has demonstrated that both sleep and physical activity (PA) are independently associated with various indicators of mental health among adults. However, their joint contribution to mental health has received limited attention. The present study used cross-sectional data from the Mental Health Million Project to examine the independent and joint effects of sleep and PA on mental health among a global sample of adults, and whether these effects differ among individuals receiving mental health treatment.

METHOD

The sample included 200,743 participants (33.1% young adults, 45.6% middle-aged adults, 21.3% older adults; 57.6% females, 0.9% other) from 213 countries, territories, and archipelagos worldwide that completed a comprehensive 47-item assessment of mental health including both problems (i.e., ill-being) and assets (i.e., well-being): the Mental Health Quotient. Participants also reported their weekly frequency of PA and adequate sleep, and mental health treatment status. A series of generalized linear mixed models were computed.

RESULTS

Independent dose-response associations were observed, whereby greater amounts of PA and adequate sleep were each associated with better mental health. In addition, a synergistic interaction was observed in which the positive correlation of PA with mental health was strengthened with greater frequency of adequate sleep. These benefits were less pronounced among adults receiving mental health treatment.

CONCLUSION

While findings suggest sleep can help to offset the negative influence of a physically inactive lifestyle (and vice versa), our results point to a "more is better" approach for both behaviors when it comes to promoting mental health.

Frequency, intensity and duration of muscle strengthening activity and associations with mental health

OBJECTIVES

Despite growing emphasis on the benefits of physical activity for promoting mental health, inclusion of muscle-strengthening (MS) (e.g., body-weight exercises, resistance machines) activities is limited. Notably, few studies collectively assess MS behavioural frequency, duration, and intensity. To address the gap, the current study examined associations between frequency (days), intensity (rating of perceived exertion in relation to repetitions in reserve [RPE/RIR]), and duration (minutes per typical session) of MS activities on anxiety, depression, and mental well-being.

METHOD

A cross-sectional study of 601 participants (Mean age = 30.92 years [SD = 12.70]; 57.7 % female) across Ireland was conducted. Participants completed a self-report questionnaire containing MS instruments previously used, or adapted from valid and reliable measures (i.e., International Physical Activity Questionnaire IPAQ, RPE/RIR), alongside, the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8) and the Mental Health Continuum- Short Form (MHC-SF). A multivariate regression model was tested in MPLUS, using dummy coding for MS frequency in relation to no activity (i.e., 0-days) non-adherence (i.e., 1-day), adherence (i.e., 2-days) and enhanced adherence (i.e., ≥3 days) to the MS public health guidelines, with the mental health variables representing the dependent variables. Intensity and duration were specified in the model as continuous variables; gender and age were included as statistical controls.

RESULTS

Three or more days engaged in MS activities was associated with fewer anxiety (β = -0.12, p < .05) and depression (β = -0.14, p < .01) symptoms. Increased intensity had a negative association with anxiety (β = -0.10, p < .05) and depression (β = -0.15, p < .001). Unexpectedly, adherence to the MS guidelines (2-days) did not predict any of the mental health outcomes, whereas 1-day of MS activity was associated with fewer depression symptoms (β = -0.11). No effects were observed for mental well-being, and MS duration exerted a null effect across all mental health outcomes.

CONCLUSION

Higher frequency and intensity of MS activities may protect against anxiety and depression symptoms. Doing some MS activities (at least 1-day) is likely more beneficial than none for depression. Evidence-based, MS interventions may help curb mental illness rates, and future longitudinal, intervention-based research could consider inclusion of MS frequency, intensity and duration variables to enhance efforts to identify at-risk groups and trends within physical activity and mental illness surveillance.

Adherence to aerobic and muscle-strengthening activities guidelines: a systematic review and meta-analysis of 3.3 million participants across 32 countries

OBJECTIVE

To estimate the global prevalence of meeting the WHO guidelines for both aerobic and muscle-strengthening activities (MSA) in populations aged ≥5 years, and whenever possible to explore this prevalence according to sociodemographic and lifestyle factors.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

Five databases were systematically searched for studies published from inception to September 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Articles with representative samples aged ≥5 years reporting the prevalence of meeting both aerobic and MSA guidelines were included.

RESULTS

Twenty-one studies comprising 3 390 001 individuals from 32 countries were included. Overall adherence to the aerobic and MSA guidelines was 17.12% (95% CI 15.42% to 18.88%) in adults ≥18 years (n=3 346 723). Among adolescents aged 12-17 years, adherence to both guidelines was 19.74% (95% CI 14.72% to 25.31%) (n=43 278). No studies reported data for children aged 5-11 years. Women, older age, low/medium education levels, underweight or obesity, and poor and moderate self-rated health were associated with lower adherence to the physical activity guidelines (p<0.001) among adults, although the prevalence remained very low in all cases. Subgroup analyses were not conducted with children and adolescents due to a lack of studies.

CONCLUSIONS

Only one out of five adolescents and adults met the recommended combined aerobic and MSA guidelines. Large-scale public health interventions promoting both types of exercise are needed to reduce the associated burden of non-communicable diseases.

PROSPERO REGISTRATION NUMBER

CRD42022338422.

Optimising the effects of physical activity on mental health and wellbeing: A joint consensus statement from Sports Medicine Australia and the Australian Psychological Society

OBJECTIVES

This consensus statement from Sports Medicine Australia and the Australian Psychological Society aims to provide guidance to practitioners on the ways that physical activity can be promoted to maximise benefits to mental health.

METHODS

Following the Clinical Consensus Statement protocol, an expert group comprised of eight members with expertise in physical activity and mental health articulated recommendations regarding five physical activity contextual factors: type, physical environment, delivery, domain, and social environment.

RESULTS

To optimise the mental health benefits of physical activity, we recommend: i) activity selection be guided by factors associated with adherence and enjoyment as opposed to any specific type (type); ii) facilitators (i.e., teachers, coaches, instructors, practitioners) deliver organised physical activity sessions using an instructional style that satisfies individuals' basic needs for autonomy, competence and social connection (delivery); iii) participation in physical activity with others who provide support, facilitate positive interactions, or make people feel valued, so long as it does not undermine a preference to be active alone (social environment); iv) where possible and appropriate, some physical activity should be undertaken outside in pleasant natural environments (physical environment); and, v) at least some physical activity be undertaken during leisure-time or via active travel, where possible prioritising activities one personally chooses to undertake (domain).

CONCLUSIONS

The type, domain, physical and social environment of physical activity, as well as the way in which it is delivered, will determine mental health outcomes. Practitioners can use these recommendations to optimise the effects of physical activity on mental health.

Adherence to aerobic and muscle-strengthening components of the physical activity guidelines and mental health

Despite a clear distinction between aerobic and muscle strengthening (MS) components in the physical activity guidelines, public health surveillance has largely focused only on aerobic components, limiting the reach of epidemiological research on the physical activity guidelines. Hence, this study investigated the association between adherence to both components (i.e. aerobic and muscle-strengthening) of the World Health Organization’s physical activity guidelines and mental health among the college student population. A cross-sectional study was conducted among a nationally representative sample of Irish college students (7088 participants, M age: 23.17 years; 50.9% female). Participants were categorized as meeting both components of the guidelines (n = 41%), only the aerobic component (n = 25.3%) or the MS component (n = 7.3%), and neither (n = 26.4%). Group membership effects on mental health was determined through mixed univariate ANOVAs, with a Bonferroni correction for post hoc analyses to assess multiple comparisons. Results revealed that meeting both components of the guidelines was significantly (all p &lt; 0.01) associated with greater self-reported happiness, body image and general health, and less mental ill-being, relative to all other respective groupings. Meeting aerobic or MS components in isolation was significantly (p &lt; 0.05) associated with better happiness, general health and body image compared to not meeting either component. To conclude, 59% of the college-aged population are insufficiently active, and adherence to both guideline components is positively associated with mental health. Co-produced, evidence-based, physical activity interventions are needed in students and could contribute to mental health promotion.

Associations between pre-COVID-19 physical activity profiles and mental wellbeing and quality of life during COVID-19 lockdown among adults

The COVID-19 pandemic has been detrimental to the physical and mental health and wellbeing of people across the globe. Regular physical activity has consistently demonstrated an array of health benefits, but the impact of regular physical activity habits pre-pandemic on health and wellbeing during the pandemic is largely unknown. The purpose of this study was to identify distinct pre-COVID-19 lockdown physical activity profiles [i.e., walking, leisure-time moderate-vigorous physical activity (MVPA), domestic MVPA and muscle strengthening exercise] and assess whether these profiles were associated with mental wellbeing and quality of life during COVID-19 lockdown. A total of 442 adults (Mage = 43.97 ± 13.85; 75.6% female) from Melbourne, Australia completed an online questionnaire measuring pre-COVID-19 physical activity, including walking habits, leisure-time MVPA, domestic MVPA, and muscle strengthening exercise - and completed measures of mental wellbeing and health related quality of life. Latent profile analysis identified five distinct profiles that differed in terms of levels of walking, leisure-time MVPA, domestic MVPA and muscle strengthening exercise. Based on the observed pre-COVID-19 lockdown profiles, it appears that high levels of MVPA and muscle strengthening exercise may serve as a protective factor against the potential negative impact of a global pandemic lockdown on mental wellbeing and quality of life.

Aerobic or Muscle-Strengthening Physical Activity: Which Is Better for Health?

ABSTRACT

The Physical Activity Guidelines recommend performing 150 min of moderate- to vigorous-intensity aerobic physical activity (MVPA) per week. These guidelines also recommend muscle-strengthening physical activity (MSPA) on ≥2 d·wk-1 for additional benefits including muscular fitness and bone health. The majority of the scientific evidence supporting the PA recommendations for health comes from studies of MVPA while the possible contributions of MSPA in these findings have been overlooked historically. Emerging evidence suggests that MSPA can independently protect against major cardiometabolic risk factors, chronic diseases, and mortality. Additional data from clinical trials indicate that many of the well-known health benefits of exercise, like improvements in cardiovascular disease risk factors, are more robust with combined MVPA and MSPA. This review will clarify the relative benefits of MSPA versus MVPA on health-related outcomes to determine the best type of PA for health.

Correlates of and changes in aerobic physical activity and strength training before and after the onset of COVID-19 pandemic in the UK: findings from the HEBECO study

OBJECTIVES

Understanding changes in moderate to vigorous aerobic physical activity (MVPA) and muscle-strengthening activity (MSA) at the start of the COVID-19 pandemic and their correlates (socio-demographics, health characteristics, living and exercise conditions and pre-pandemic MVPA/MSA) can inform interventions.

DESIGN

A cross-sectional analysis of retrospective and concurrent data on MVPA/MSA.

SETTING

An online survey in the UK.

PARTICIPANTS

2657 adults (weighted n=2442, 53.6% women) participating in the baseline survey (29 April 2020-14 June 2020) of the HEalth BEhaviours during the COVID-19 pandemic (HEBECO) study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Meeting WHO-recommended levels for MVPA/MSA/both (vs meeting neither) during the first lockdown and changes in MVPA/MSA from before to since the COVID-19 pandemic following stratification for pre-pandemic MVPA/MSA.

RESULTS

A third of adults maintained (30.4%), decreased (36.2%) or increased (33.4%) MVPA. For MSA, the percentages were 61.6%, 18.2% and 20.2%, respectively. MVPA increased or decreased by an average of 150 min/week and 219 min/week, respectively, and MSA by 2 days/week. Meeting both MSA+MVPA recommendations since COVID-19 (vs meeting neither) was positively associated with meeting MVPA+MSA before COVID-19 (adjusted OR (aOR)=16.11, 95% CI 11.24 to 23.07) and education: post-16 years of age (aOR=1.57, 95% CI 1.14 to 2.17), and negatively associated with having obesity (aOR=0.49, 95% CI 0.33 to 0.73), older age (65+ years vs ≤34 years; aOR=0.53, 95% CI 0.32 to 0.87) and annual household income of <50 000 GBP (aOR=0.65, 95% CI 0.46 to 0.91). The odds for decreasing MVPA were lower for white ethnicity (aOR=0.62, 95% CI 0.44 to 0.86), education: post-16 years of age (aOR=0.73, 95% CI 0.58 to 0.91) and access to garden/balcony (aOR=0.75, 95% CI 0.60 to 0.94), and were higher for those living in total isolation (aOR=3.81, 95% CI 2.33 to 6.23), with deteriorated psychological well-being (aOR=1.40, 95% CI 1.15 to 1.71) and conditions limiting physical activity (aOR=1.74, 95% CI 1.27 to 2.39). The odds for decreasing MSA were higher for having overweight (aOR=1.88, 95% CI 1.39 to 2.55), obesity (aOR=23.38, 95% CI 2.23 to 5.14) and being employed (aOR=1.81, 95% CI 1.34 to 2.46).

CONCLUSION

Aerobic and strength training were differently impacted during the first UK lockdown, with poorer outcomes associated with older age, lower education and higher body mass index. Targeted interventions may be required to avoid pandemic-related inequities in physical activity.

UK Adults' Exercise Locations, Use of Digital Programs, and Associations with Physical Activity During the COVID-19 Pandemic: Longitudinal Analysis of Data From the Health Behaviours During the COVID-19 Pandemic Study

BACKGROUND

Digital physical activity (PA) program use has been associated with higher PA guideline adherence during COVID-19 pandemic confinements. However, little is known longitudinally about exercise locations (inside vs outside the home environment), digital program use, and their associations with moderate-to-vigorous PA (MVPA) and muscle-strengthening activities (MSAs) during the pandemic.

OBJECTIVE

The aims of this study were to assess the relationship between exercise location and use of digital programs with PA guideline adherence during the COVID-19 pandemic, describe how individuals exercised inside and outside of their home environments, and explore which sociodemographic and contextual factors were associated with exercise locations and digital PA program use.

METHODS

Active UK adults (N=1938) who participated in the 1-month follow-up survey of the Health Behaviours During the COVID-19 Pandemic (HEBECO) study (FU1, June-July 2020) and at least one more follow-up survey (FU2, August-September; FU3, November-December 2020) reported exercise locations and types of exercises inside and outside their homes, including digital programs (online/app-based fitness classes/programs), MVPA, and MSA. Generalized linear mixed models were used to assess associations of exercise location and digital PA program use with PA guideline adherence (MVPA, MSA, full [combined] adherence), and predictors of exercise location and digital program use.

RESULTS

As the pandemic progressed, active UK adults were less likely to exercise inside or to use digital PA programs compared with periods of initial confinement: 61% (95% CI 58%-63%; weighted n=1024), 50% (95% CI 48%-53%; weighted n=786), and 49% (95% CI 46%-51%; weighted n=723) performed any exercise inside their homes at FU1, FU2, and FU3, respectively. At FU1, FU2, and FU3, 22% (95% CI 21%-25%; weighted n=385), 17% (95% CI 15%-19%; weighted n=265), and 16% (95% CI 14%-18%; weighted n=241) used digital PA programs, respectively. Most participants who exercised inside already owned indoor equipment, used digital PA programs, or had their own workout routines, whereas MVPA and gentle walking were the most common exercise types performed outside the home. Being female, nonwhite, having a condition limiting PA, indoor exercising space, a lower BMI, and living in total isolation were associated with increased odds of exercising inside the home or garden compared with outside exercise only. Digital PA program users were more likely to be younger, female, highly educated, have indoor space to exercise, and a lower BMI. While exercising inside was positively associated with MSA and exercising outside was positively associated with MVPA guideline adherence, both inside (vs outside only) and outside (vs inside only) activities contributed to full PA guideline adherence (odds ratio [OR] 5.05, 95% CI 3.17-8.03 and OR 1.89, 95% CI 1.10-3.23, respectively). Digital PA program use was associated with a higher odds of MSA (OR 3.97-8.71) and full PA (OR 2.24-3.95), but not with MVPA guideline adherence.

CONCLUSIONS

During the COVID-19 pandemic, full PA guideline adherence was associated with exercising inside and outside of one's home environment and using digital PA programs. More research is needed to understand the reach, long-term adherence, and differences between digital PA solutions.

Correlates of Meeting the Muscle-Strengthening Exercise Guidelines in Children and Adolescent

This study aimed to explore the potential correlates of muscle-strengthening exercise (MSE) in Chinese children and adolescents. A convenient sample (n = 3733) was recruited into this study. Self-reported questionnaires were used to collect information on sex, grade, ethnicity, residence, family composition, moderate to vigorous physical activity (MVPA), family income, parent's education level and MSE in children and adolescents as well as their parent(s). The prevalence of meeting the MSE guidelines was 62.1%. Children and adolescents who were in primary or middle school were more likely to meet the MSE guidelines ([primary school] OR = 2.33, 95% CI: 1.16-4.68; [middle school] OR = 4.62, 95% CI: 2.27-9.39). Children and adolescents with Han ethnicity had a higher likelihood to meet the MSE guidelines (OR = 1.97, 95% CI: 1.37-2.83). Children and adolescents meeting the MVPA recommendation were more likely to meet the MSE guidelines (OR = 5.41, 95% CI: 3.97-7.37). Relative to those who had a parent not meeting the MSE guidelines, those with either father or mother meeting the MSE guidelines were more likely to meet the MSE guidelines (OR = 1.32, 95% CI: 1.13-1.55). Our study may offer evidence for future MSE interventions in Chinese children and adolescents.