Longitudinal associations between physical activity, anxiety, and depression in adults with long-term physical disabilities

The Impact of Physical Activity on the Disability-Related Stress of Individuals With Physical Disabilities: A Five-Year Longitudinal Study

People with physical disabilities report a higher prevalence of psychological distress and chronic stress than those without disabilities. Participation in physical activity (PA) has been considered an effective coping strategy to deal with stressors and improve the mental health of people with disabilities. However, very little research has been conducted to explore the relationship between disability-related stress and PA participation by people with physical disabilities longitudinally on an international scale. Therefore, the purpose of this study was to investigate the effect of different levels of PA participation on disability-related stress among people with physical disabilities longitudinally. This study used data from the second wave of the Korean Panel Survey of Employment for the Disabled (PSED) from 2016 to 2022. The results of generalised estimated equation modelling indicated that higher levels of PA participation were associated with lower disability-related stress levels over time in the Koreans with physical disabilities who participated in our study. Our findings suggest that participating in 130-150 min of PA per week is the optimal range for reducing disability-related stress. The practical implications of improving the mental health of people with physical disabilities and future research directions were discussed.

Illicit drug use among adolescents and young adults with impairments in the US: A cross-sectional analysis of the National Survey on Drug Use And Health

OBJECTIVE

The purpose of this cross-sectional analysis is to compare the degree to which adolescents and adults with and without impairments in the US engage in illicit drug use.

METHODS

This cross-sectional study utilized data from the 2022 National Survey of Drug Use and Health. Impairment status (mobility, cognitive, hearing, vision, self-care, and communication impairments), illicit drug use (cocaine, crack, heroin, hallucinogens, LSD, ecstasy and molly, inhalants, and methamphetamine), and demographic variables were measured using self-report. Weighted prevalence estimates for illicit drug use across each category were provided. Group differences in drug prevalence between individuals with and without impairments were examined, then logistic regressions estimated crude and adjusted odds of drug use among impairment groups by age. Prevalence of use and age of first time use for illicit drugs were explored across impairment type.

RESULTS

The sample comprised of 35,921 individuals, with an estimate of 12.9 % experiencing at least one impairment. Among emerging adults, hallucinogens were the highest reported used drug in the past year, with a significantly higher percentage of those with impairments (12.8 %, 95 % CI: 1.5, 9.6), compared to adults without impairments (7.1 %, 95 % CI: 6.3, 8.0), reporting recent use. Individuals with impairments (mean = 16.2 years) were significantly younger when they first tried an illicit drug compared to peers (mean = 18.1 years).

CONCLUSIONS

Overall, individuals with impairments were more than twice as likely to engage in illicit drug use compared to counterparts. People with impairments were younger, on average, when they first tried any illicit drugs.

Leisure participation and mental health among middle-aged and older adults with physical disabilities: a systematic review

PURPOSE

To examine the effects of leisure participation on mental health for middle-aged and older adults with physical disabilities.

MATERIALS AND METHODS

A systematic review conducted in March-May 2022 with an updated search in February 2024 retrieved data from MEDLINE, CINAHL, PsycInfo, and EMBASE. Inclusion criteria included a study population with a mean age ≥45 years and with physical disability, and original, peer-reviewed literature. Exclusion criteria included non-community-dwelling participants, participants outside the specified age range, review studies, intervention studies not focused on leisure or intrinsically motivated activities, and studies without full text. The Oxford 2011 Levels of Evidence, NIH study quality assessment tool, and Cochrane ROBINS-I tools were used to assess the evidence strength and the risk of bias. A data extraction table was created to analyze and synthesize the results.

RESULTS

Eleven articles with 18,681 total participants were thoroughly reviewed. Most studies were longitudinal survey, cohort, and cross-sectional studies. Evidence indicates that leisure participation benefits mental health (depression, anxiety, happiness, and well-being) and other health-related outcomes.

CONCLUSIONS

Findings should be interpreted with caution due to lack of high-level evidence. Future research should consider alternative study designs in addition to RCTs to better capture the individualized nature of leisure activities.

Leisure-Time Physical Activity Participation in Middle-Aged and Older Adults With a Spinal Cord Injury in Australia

Objectives

Adults with spinal cord injury (SCI) are often sedentary, increasing their risk of cardiometabolic diseases. Leisure-time Physical Activity (LTPA) is physical activity completed during recreation time for enjoyment. We aimed to quantify LTPA in people ≥45 years with SCI and to explore its relationship with participants' characteristics.

Methods

This is a secondary analysis on a subset of the Australian International SCI Survey in participants ≥45 years, at least 12 months post-injury. We described levels of LTPA and used multivariable regressions to estimate the associations between participant characteristics and LTPA.

Results

Of 1,281 participants (mean age: 62.7 years, mean time since injury: 18.7 years; 74% males) 44% reported no participation in LTPA. The average LTPA participation was 197 (SD 352) minutes per week (median: 50). Females (β = -62.3, 95% CI [-112.9, -11.7]), and participants with non-traumatic injuries (β = -105.2, 95% CI [-165.9, -44.6]) performed less LTPA. Time since injury was not associated with moderate-to-heavy LTPA (LR: Probability > F = 0.785).

Conclusion

LTPA promotion in the SCI population ≥45 years focusing on females and non-traumatic injuries is warranted.

Depression in persons with disabilities: a scoping review

Individuals with disabilities are more vulnerable to depression development than the general population. This study sought to map the evidence on current knowledge of depression, intervention strategies, and assessment tools among people with disabilities. This review was conducted following Arksey and O'Malley's scoping review methodology framework. An electronic search was performed on four English databases: PubMed, Cochrane Library, PsycINFO, and Web of Science. The original search returned 1802 results, with 1,116 from Web of Science, 626 from PubMed, 25 from Cochrane, and 35 from PsycINFO. After removing duplicates, 786 articles were chosen for the title and abstract screening processes. Finally, 112 full-text publications were deemed eligible, with 41 papers being included in this scoping review for analysis. A large proportion (32; 78.04%) of the studies chosen were cross-sectional, 14 (34.14%) of them reported general disability, 12 (29.26%) used a patient health questionnaire (PHQ-9) to measure depression, and 14 (34.14%) had interventions, including cognitive behavioral therapy, psychological counseling, social support, and physical activity. All interventions successfully reduced the severity of the depression. Cognitive behavioral therapies and psychological counseling were widely used interventions that had a significant impact on reducing depression. More randomized controlled trials are required, and they should focus on individuals with specific disabilities to provide disability-specific care that can improve the quality of life for disabled individuals.

"It Doesn't Die Within You": Outdoor Recreation Participation Following Spinal Cord Injury

Although some people with spinal cord injury (SCI) return to outdoor recreation, many have low activity levels and encounter significant environmental barriers. The purpose of the study was to describe how people with SCI engage in outdoor recreation activities, what meaning they attribute to these, and to inform occupational therapists in promoting outdoor recreation post-SCI. The study used qualitative, descriptive phenomenology. Thirteen participants completed semi-structured interviews, and data were analyzed using thematic analysis. Outdoor recreation contributes to personal well-being. It is a way to share life with loved ones and other disabled people. Having the right equipment and using a trial-and-error approach facilitated participation, which was sometimes supported and frequently constrained by physical, built, and information environments. Findings suggest implications for occupational therapists in the areas of direct intervention, entrepreneurship, and advocacy. These are consistent with the American Occupational Therapy Association Vision 2025 to collaborate for inclusion and accessibility in occupational performance.

The Effects of Physical Activity, Exercise, and Sports Programs on Depressive Symptoms in Individuals with Disabilities: A Systematic Review with Meta-Analysis

Studies show that physical activity, exercise, or sport reduces depressive symptoms in the general population. However, little is known about its effects on individuals with disabilities. Thus, this systematic review with meta-analysis aims to verify the effects of this practice on depressive symptoms in individuals with disabilities. The Pubmed, Web of Science, Scopus, and SportDiscus databases were used, with several descriptors and Boolean operators. A total of 1509 studies were identified through searching the databases. Studies that met the eligibility criteria were subsequently assessed for their methodological quality (Downs and Black scale), and a meta-analysis was performed. The Z-values that were obtained to test the null hypothesis, which states that there is no difference in means, showed Z = -2.294 and a corresponding p-value = 0.022. We can, therefore, reject the null hypothesis in the sense that exercise seems to reduce depressive symptoms in individuals with disabilities. In sum, participants from the intervention group presented more probability of reducing depressive symptoms when compared to the control group (approximately -1.4 standard differences in means; 95% CI -2.602 to -0.204).

Predictors of quality of life of individuals living in Brazil with spinal cord injury/disease

STUDY DESIGN

A cross-sectional, descriptive study.

OBJECTIVES

To investigate the demographic, clinical behavioral, and rehabilitation predictors of the quality of life (QoL) of people with spinal cord injury/disease (SCI/D) in a middle-income country.

METHOD

Ninety-five participants living in the community were evaluated with the following instruments: World Health Organization Quality of Life - Bref; International SCI Core DataSet; Clinical Interview; Spinal Cord Secondary Conditions Scale and Patient Health Questionnaire; Numerical Pain Intensity Scale; Short-Form 12 Health Survey - Item 8 (how much pain hinders activities); Patient Health Questionnaire 2, Numerical Fatigue Scale. Data were analyzed via Spearman correlation, univariate analysis, and multiple regression to explain the effects associated with quality-of-life predictors.

RESULTS

The main factors that decreased quality of life were fatigue (by 11.5%), depression (by 5.5-12.8%), pain (by 1.3 in total life quality, in the physical domain by 8.6-9.6%), sores (15.6% in the physical domain only). The practice of sports increased the total quality of life by 14.4%, in the physical domain by 11.9%, in the psychological domain by 17.2%, and in the social domain by 23.7%.

CONCLUSIONS

Fatigue, risk of depression, pain, and the presence of sores are predictors of poor quality of life, and sports are a predictor of a better quality of life, for people with spinal cord injury. Multidisciplinary rehabilitation, in addition to policies, to increase accessibility and social inclusion, and incentives or subsidies for the practice of sports could improve QoL following SCI/D.

INFLUENCE OF ATHLETES’ ANXIETY ON COMPETITION RESULTS

ABSTRACT Introduction Athletes naturally feel anxiety and tension during competition, where mild worry and stress can further encourage athlete performance, but severe anxiety seriously interferes with athlete performance on the field. Objective Study the effects of anxiety on competition results. Methods This paper analyzes 40 athletes from various sports, use the relevant scoring methods on the competition situation anxiety scale, makes statistics on athletes’ psychological scores and athletes’ anxiety with different competition outcomes, and draws relevant charts aiming to better observe the psychological situation of athletes with different competition levels. Results Athletes have different types of anxiety in the competition process, and athletes with different competition outcomes also have different anxiety emphases. Among them, athletes with high sports levels often feel nervous and anxious about the results of competitions and the fiercest competition. The degree of anxiety about their actions is relatively low; athletes with lower performance are just the opposite. Conclusion Coaches should perform targeted psychological counseling to adjust the mentality of athletes to achieve a better competitive state. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

MOOD STATES AND QUALITY OF LIFE IN PARALYMPIC BOCCIA ATHLETES IN THE COVID-19 PANDEMIC

ABSTRACT Introduction: Although studies have been conducted in the athlete population during the pandemic, its impacts on Paralympic athletes are still unknown. Objective: To evaluate the mood and quality of life of Paralympic boccia players during the COVID-19 pandemic period. Method: Questionnaires assessing mood, quality of life, and demographic data were sent electronically via social media. The study included 43 athletes from all functional classes (BC1 = 8, BC2 = 12, BC3 = 11, and BC4 = 11) and four regions of Brazil (Northeast = 12, Southeast = 12, Central-West = 3, and South = 17). ANOVA, t test, and similar non-parametric tests were used, with the respective effect sizes (ES). Results: Regarding mood states, BC4 athletes differed from BC1 athletes in the depression subscale score (25.5 vs. 14.5, p = 0.026, ES=1.47). The fatigue subscale score differed between BC4 and BC1 athletes (17.8 vs. 10.4, p = 0.023, ES=1.38) and between BC4 and BC2 athletes (17.8 vs 10.3, p = 0.008, ES=1.32). BC4 athletes had higher total mood disturbance (TMD) values than BC1 (175 vs. 141, p = 0.025, ES=1.35) and BC2 (175 vs.141, p = 0.025, ES=0.97) athletes. Lower stress (18.5 vs.21.8, p = 0.027, ES=0.64) and TMD (148.0 vs 162.0; p = 0.044; ES= 0.53) values were observed among the national level athletes. In terms of quality of life, differences were found between BC4 and BC2 athletes in the psychological health domain (3.73 vs. 4.49, p = 0.024, ES=0.89) and between athletes from the Northeast and South in the environment domain (3.39 vs. 4.18, p=0.030, ES=0.44). Conclusion: BC4 athletes are more susceptible to negative mood and quality-of-life perceptions. Additionally, athletes from the Northeast region may have poorer perceptions of quality of life related to the environment in which they live. Level of evidence III; Retrospective study.

Initial Psychometric Evidence of Physical Inactivity Perceived Experience Scale (Pipes): COVID-19 Pandemic as a Pilot Study

Aims

Our study aimed to develop a two-factor self-administered orthogonal questionnaire to assess the experience of perceived physical inactivity, to test its psychometric properties, to confirm its relationships with fear of COVID-19, and finally, with perceived stress during the pandemic.

Methods

A total of 481 Tunisian subjects collected in several cities, aged from 16 to 67 years with a mean age = 32.48 ± 9.46, and of both sexes participate in our study with (male: 51.8%) and (female: 48.2%), divided according to the level of study into three categories. All subjects voluntarily answered the PIPES questionnaire, the IPAQ scale, the COVID-19 fear scale and the PSS-10 test.

Results

The results of the exploratory and confirmatory factor analysis supported the robustness of the tool measure. In addition, examination of configurational, metric, scalar, and strict invariance supported the equivalence of the structure by gender and educational level. Concurrent validity was established by the positive association of a negative perception of physical inactivity with scores measured by the IPAQ scale and a negative association with scores of COVID-19 fear and perceived stress. Whereas, a positive perception of physical inactivity from the COVID-19 scale was negatively associated with the IPAQ and positively associated with fear of COVID-19 and perceived stress.

Conclusion

The PIPES-10 scale can be used to measure the perception of physical inactivity in different situations.

Factors associated with anxiety in males and females in the Lebanese population during the COVID-19 lockdown

Image, graphical abstract.

Physical Activity and Health-Related Quality of Life in Adults With a Neurologically-Related Mobility Disability During the COVID-19 Pandemic: An Exploratory Analysis

Background: During the coronavirus-19 (COVID-19) pandemic various containment strategies were employed. Their impact on individuals with neurological conditions, considered vulnerable to COVID-19 complications, remains to be determined.

Objective: To investigate associations between physical activity and health-related quality of life outcomes in individuals with a neurological condition during government mandated COVID-19 restrictions.

Methods: An e-survey assessing fear of COVID-19, physical activity level and health-related quality of life outcomes (functional disability and pain, anxiety and depression, loneliness, fatigue, and vitality) was distributed to individuals with a neurologically-related mobility disability living in the United Kingdom. Open-ended questions were also included to contextualize barriers and facilitators to engage in physical activity during the COVID-19 pandemic. Gamma-weighted generalized linear models and tree-structured regression models were employed to determine the associations between physical activity and health-related quality of life.

Results: Of 199 responses, 69% reported performing less physical activity compared to pre-pandemic. Tree-structured regression models revealed that lower leisure-time physical activity was significantly associated (p ≤ 0.009) with higher depression and fatigue, but lower vitality. The closure of leisure facilities and organized sport (27%) was the most commonly cited barrier to engage in physical activity, while 31% of participants mentioned concerns around their physical and mental health as a facilitator.

Conclusion: Our analysis identified homogenous subgroups for depression, fatigue, and vitality based specifically on leisure-time physical activity cut points, irrespective of additional demographic or situational characteristics. Findings highlight the importance of and need to safely promote leisure-time physical activity during the COVID-19 pandemic in this at-risk population to help support health-related quality of life.

The impact of COVID-19 home confinement on neuromuscular performance, functional capacity, and psychological state in Spanish people with Multiple Sclerosis

Background

The COVID-19 pandemic caused a global confinement of more than 2 months in Spain. As a result, the general population has significantly decreased their physical activity levels. The consequences of this abrupt, sedentary lifestyle in Spanish people with Multiple Sclerosis (pwMS) were unknown. Our aim was to examine the impact of COVID-19 home confinement on neuromuscular performance, functional capacity, physical self-perception, and anxiety in pwMS.

Methods

Eighteen pwMS (8:10 men/women, age: 43.41±10.88 years, Expanded Disability Status Scale: 2.85±1.34) participated in the study. Rate of force development (RFD) and maximal voluntary isometric contraction during knee extension in both legs, Timed-Up and Go test (TUG), sit-to-stand test, 6 min walk test, 10 m walk test, Physical-Self Perception Questionnaire (PSPQ) and State-Train Anxiety Inventory (STAI) were performed just before and after home confinement.

Results

A non-significant moderate effect (p = 0.07; ES = -0.48) was observed in the time in the sit-to-stand test compared to pre-home confinement. There was a significant increase in the time in TUG (p = 0.02; ES = -0.67). The PSQP score decreased (p = 0.01; ES = 0.79) and STAI-state increased (p = 0.01; ES = -0.65) following home confinement.

Conclusion

Home confinement had an impact on functional capacity, physical self-perception and state anxiety. However, neuromuscular performance was not altered after home confinement.

Impact of the COVID-19 Pandemic on Life Space Extent and Apathy: A Comparison of Competitive Japanese Swimmers with and without Disabilities

Changes in the daily lives and mental health of people with disabilities due to the coronavirus disease (COVID-19) pandemic have not been reported. The Japanese government closed public facilities, including swimming pools, during the first wave of COVID-19, and many competitive swimmers lost their places of activities. This study aimed to investigate the impact of the COVID-19 pandemic on life space and apathy among swimmers and investigated differences in the impact on swimmers with and without disabilities. A total of 39 competitive swimmers participated in this study, including 11 male and nine female swimmers with disabilities (swimmers with disabilities = para-swimmers), and e11 male and eight female swimmers without disabilities. Baseline and follow-up web-based questionnaire surveys were conducted, and changes in life space and apathy scale (AS) were assessed. Female para-swimmers showed significantly lower apathy than female able-bodied subjects (para, during; 16.0 ± 1.9; after, 12.8 ± 3.2; non-disabled; during, 10.5 ± 4.4; after, 10.6 ± 4.8; p < 0.05). Female swimmers with disabilities may be more likely to experience worsening mental health due to changes in their lifestyle.

"Enticing" but Not Necessarily a "Space Designed for Me": Experiences of Urban Park Use by Older Adults with Disability

Urban parks are spaces that can enhance older adults’ physical, social and psychological wellbeing. As the prevalence of older adults with disability increases, it is important that urban parks are accessible to this population so that they too might gain health benefits. There is limited literature investigating the experiences of urban parks by older adults with disability. This qualitative study, set in a region of New Zealand, explored the experiences, including accessibility, of urban parks by 17 older adults (55 years and older) with self-reported disabilities. Three focus groups (n = 4, 5 and 4 people) and four individual interviews were undertaken. Data were analyzed using the General Inductive Approach. Two primary themes of “Enticing” and “Park use considerations” are presented. Urban parks and green spaces are perceived to provide an environment for older adults with a disability to improve their physical, psychosocial and spiritual health, and social connectedness. Parks that are not age, ability or culture diverse are uninviting and exclusive. Meaningful collaboration between park designers, city councils and people with disability is required to maximize the public health benefits of parks and make parks inviting and accessible for users of all ages, cultures and abilities. Park co-design with people with disability may provide one means of improving accessibility and park usability and thus park participation by older adults with disability.

A Descriptive Cross-Sectional Study of Manipulative Dexterity on Different Subtypes of Multiple Sclerosis

Background

Manipulative dexterity impairments affect 76% of individuals with multiple sclerosis (MS). Patients with MS can experience reduced skill when performing both basic activities of daily living and instrumental activities of daily living. Many studies consider that physical rehabilitation leads to a decrease in the level of disability, especially at the mild and moderate stages of the disease. However, most studies fail to distinguish between the different MS subtypes.

Purpose

Our aims were (1) to describe the manipulative skills of people according to the different subtypes of MS, (2) to analyze the correlation between dexterity and self-perception variables, and (3) to identify possible predictors of functionality. Study Design. A descriptive cross-sectional study.

Methods

30 individuals with MS. The measurement tools used were the ABILHAND, the Purdue Pegboard Test (PPT), the Nine-Hole Peg Test, and the Box and Block Test.

Results

All subtypes of MS obtained lower scores for manipulative dexterity compared to normal skill levels, with individuals with primary progressive MS displaying the lowest values. However, the analysis of differences between the different subtypes did not reveal statistically significant intragroup differences. In addition, differences were found regarding the effect size of practically all the variables analyzed for both manipulative dexterity (PPT, NHPT, and BBT) and the self-perception of ADLs (ABILHAND), for which high values (d _r = 0.72) and very high values (d _r = 1.46) were obtained.

Conclusions

Although no significant differences were found between the different types of MS, the assessment of manual dexterity and perceived efficacy of daily activities must be considered as prognostic factors in the progression of the disease. These findings may help support further research on targeted interventions to improve dexterity deficiencies, as well as promote an improved quality of therapeutic interventions.