Cross-sectional association of exercise, strengthening activities, and cardiorespiratory fitness on generalized anxiety, panic and depressive symptoms

Association Between Frequency of Muscle-Strengthening Exercise and Depression Symptoms Among Middle and High School Students: Cross-Sectional Survey Study

BACKGROUND

Existing literature on the association between the frequency of muscle-strengthening exercise (MSE) and depression among adolescents is limited and contradictory.

OBJECTIVE

This study aimed to elucidate the association of MSE frequency with depression symptoms among middle and high school students in China.

METHODS

A total of 27,070 students in grades 7-12 from 376 middle and high schools were surveyed using an anonymous self-administered questionnaire between April and June 2022. Information on engaging in MSE was self-reported, and depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Poisson regression was used to examine the association between MSE frequency and depression symptoms.

RESULTS

Among the 27,006 eligible students, 51.6% (n=13,933) were boys, and the mean age was 15.6 (SD 1.7) years. The overall prevalence of meeting MSE recommendations (ie, engaging in MSE ≥3 days/week) was 34.6% (95% CI 32.6%-36.6%; n=9145); the prevalence was higher in boys (43.8%, 95% CI 41.8%-45.8%; 6067/13,933) than in girls (24.3%, 95% CI 22%-26.6%; 3078/13,073; P<.001). A total of 5882 (21.8%) students reported having depression symptoms. After adjustment for sociodemographic status, lifestyle factors, academic performance, and experience of physical fighting, compared to students who did not engage in MSE, the prevalence ratios (PRs) for depression symptoms were 0.98 (95% CI 0.97-0.99) for those engaging in MSE once a week, 0.95 (95% CI 0.93-0.97) for 2 days/week, 0.93 (95% CI 0.90-0.96) for 3 days/week, 0.90 (95% CI 0.87-0.94) for 4 days/week, 0.88 (95% CI 0.84-0.93) for 5 days/week, 0.86 (95% CI 0.81-0.92) for 6 days/week, and 0.84 (95% CI 0.78-0.90) for 7 days/week, respectively.

CONCLUSIONS

The overall prevalence of meeting MSE recommendations among Chinese adolescents is low. The frequency of MSE was inversely associated with depression symptoms.

Cardiorespiratory fitness and incident use of anxiolytics and antidepressants in adults. A linkage study between HUNT and the Norwegian Prescription Database

BACKGROUND

We investigated the association between cardiorespiratory fitness (CRF) and incident use of antidepressants or anxiolytics in the general adult population.

METHODS

A non-exercise prediction model was used to estimate CRF in 32,603 participants in the third wave of the Trøndelag Health Study (HUNT3; 2006-08). Data on first purchase of antidepressants and anxiolytics were obtained from the Norwegian Prescription Database. Cox regression was used to estimate hazard ratios (HRs).

RESULTS

Each 1- metabolic equivalent of task (MET) increase in CRF was associated with 4 % reduced risk of purchasing antidepressant or anxiolytic medication during follow-up (HR 0.96, 95 % Confidence interval [CI] 0.94-0.98). Compared to the low CRF tertile, participants in intermediate (HR 0.93, 95 % CI 0.87-0.98) and high (HR 0.92, 95 % CI 0.86-0.98) CRF tertiles had reduced risk of medication purchase. Men in intermediate and high CRF tertile had lower risk of medication purchase (intermediate HR 0.87, 95 % CI 0.79-0.96; high HR 0.87, 95 % CI 0.78-0.96). Intermediate and high CRF tertiles were associated with reduced risk of medication use for younger adults (20 to <30 years old; intermediate HR 0.74, 95 % CI 0.61-0.91, high HR 0.78, 95 % CI 0.64-0.95) and middle-aged adults (30 to <65 years old; intermediate HR 0.90, 95 % CI 0.83-0.97, high HR 0.90, 95 % CI 0.84-0.98), but not in older adults (≥65 years old).

LIMITATIONS

Only information about medication purchase and not actual use was available.

CONCLUSION

Increased CRF is associated with reduced risk of anxiolytics and antidepressants purchase, with stronger effects for men and younger adults.

Association Analyses of Physical Fitness Parameters and Anxiety Symptoms in Chinese College Students

Poor physical fitness is related to many negative health outcomes, including mental disorders. However, the relationship between physical fitness and anxiety symptoms among college students remains unclear. Therefore, this study investigated whether physical fitness is related to anxiety symptoms in Chinese college students. Cross-sectional data were collected from 6635 men and 4482 women. Physical fitness was measured via a 50-m sprint, a sit-and-reach test, vital capacity, and a standing long jump for both sexes; 1000-m run and pull-up tests for males; and 800-m run and sit-up tests for females. The seven-item Generalized Anxiety Disorder Scale (GAD-7) was used to evaluate anxiety symptoms. Multivariate linear regression showed that better physical fitness was related to lower GAD-7 scores. In addition, multivariate logistic regression analysis showed that better ability in the 50-m sprint, sit-and-reach test, pull-up test, and vital capacity was related with a lower risk of anxiety symptoms in males, and better ability in the 800-m run and standing long jump was related with a lower risk of anxiety symptoms in females. In conclusion, physical fitness was inversely associated with anxiety symptoms in male and female college students. This association was also independent of confounding factors.

Physical Fitness and Dietary Intake Improve Mental Health in Chinese Adolescence Aged 12-13

Background

Mental health has become a major public health issue worldwide. Biological and epidemiological studies have suggested that diet and physical fitness play a role in the prevention or cure of mental disorders. However, further research is required to elucidate the relationship between diet, physical fitness, and mental health. The study aims to provide a theoretical basis for promoting an adolescent healthy lifestyle and preventing mental problems by exploring the relationship between physical fitness, calcium intake, calorie intake, and adolescent mental health.

Methods

A cross-sectional study of a sample of adolescents (N = 253, 12-13 years) was conducted. The study involved adolescents from three middle schools in Central Jiangsu Province, including 136 boys and 117 girls. Weight, height, and body mass index were measured. Physical fitness was scored using the Chinese National Student Physical Fitness Standard. Diet data were collected using a weighed 7-day food diary to estimate energy intake and dietary calcium intake. The mental health status of the participants was assessed using the Chinese Middle School Student Mental Health Scale. A T-test and analysis of variance were used to analyze the differences of variables between different genders and body mass index, and Pearson correlation and stepwise multiple regression were used to explore the relationship between physical fitness, dietary intake, and mental health.

Results

The height (165.13 ± 8.07), weight (55.24 ± 13.00), and strength quality (64.93 ± 21.66) of boys are higher than those of girls (161.67 ± 6.44,48.99 ± 8.97, 58.40 ± 23.75, P < 0.05), and the flexibility quality (74.59 ± 14.75) of girls is higher than that of boys (68.30 ± 20.84) (P < 0.05). There were significant differences in the total scores of speed and physical fitness (F values were 4.02187.73, 3.07, 5.95, 10.33, and 9.52, respectively, P < 0.05). There was a significant positive correlation between calcium intake, cardiopulmonary fitness, and mental health (r = 0.276, P < 0.01; r = 0.159, P < 0.05). Calcium intake and cardiopulmonary fitness could explain 8.4% of the changes in the mental health of adolescents aged 12-13(ΔR2 = 0.084, P < 0.05).

Conclusion

Adequate calcium intake and the improvement of cardiopulmonary fitness in adolescents aged 12-13 are essential for the good development of their mental health. Future research in this field should examine the prospective associations between multiple measures of physical fitness composition and other nutrients ingested and mental health outcomes, as well as intervention studies that seek to provide evidence of causality.

The mediating roles of sleep quality and sedentary behavior between physical fitness and depression among female college freshmen

Objective: This study aimed to investigate interactions among physical fitness, sleep quality, sedentary behavior, and depression among female college freshmen. Participants: A cohort of 1,514 Chinese female college freshmen (M_age = 18.8 ± .63) were recruited from four universities. Methods: Participants completed a survey assessing depression, sleep quality (sleep duration and sleep onset latency), and sedentary behavior, and performed physical fitness measurements. Results: Physical fitness indexes were associated with sleep quality and sedentary behavior (ps < .05) but not with depression. Depression was positively associated with sedentary behavior and sleep onset latency, but negatively associated with sleep duration (ps < .01). The model tests revealed that sleep quality (β = -.57, p < .01) and sedentary behavior (β = .14, p < .01) served as mediators between physical fitness and depression, respectively. Conclusions: Increasing sleep quality and minimizing sedentary behavior may build resilience to depression among Chinese female college freshmen.

Assessment of muscle-strengthening exercise in public health surveillance for adults: A systematic review

There is strong scientific evidence that muscle-strengthening exercise (i.e. use of weight machines, push-ups, sit-ups) is independently associated with a reduced risk of multiple chronic diseases (e.g. diabetes, hypertension, cardiovascular disease). However, prevalence rates for meeting the muscle-strengthening exercise guideline (≥2 times/week) are significantly lower (~20%) than those reported to meet the aerobic physical activity guideline (e.g. walking, jogging, cycling) (~50%). It is therefore important to understand public health surveillance approaches to assess muscle-strengthening exercise. The aim of this review was to describe muscle-strengthening exercise assessment in public health surveillance. Informed by the PRISMA guidelines, an extensive keyword search was undertaken across 7 electronic data bases. We identified 86,672 possible articles and following screening (n = 1140 in full-text) against specific inclusion criteria (adults aged ≥18 years, English, studies containing <1000 participants), extracted data from 156 manuscripts. Fifty-eight different survey systems were identified across 17 countries. Muscle-strengthening exercise frequency (85.3%), duration (23.7%) and intensity (1.3%) were recorded. Muscle-strengthening exercise questions varied significantly, with some (11.5%) requiring a singular 'yes' vs 'no' response, while others (7.7%) sought specific details (e.g. muscle groups targeted). Assessments of duration and intensity were inconsistent. Very few studies measured the validity (0.6%) and reliability (1.3%) of muscle-strengthening exercise questions. Discrepancy exists within the current assessment systems/surveys used to assess muscle-strengthening exercise in public health surveillance. This is likely to impede efforts to identify at risk groups and trends within physical activity surveillance, and to accurately assess associations between muscle-strengthening exercise and health-related outcomes.

[Determinants of health in adolescence: cardiorespiratory fitness and body composition]

Introduction

Introduction: cardiorespiratory fitness and body composition are determining indicators of health status during adolescence. The objective of the study was to analyze the relationship of both parameters with indicators of mental and psychosocial health, lifestyle habits, and sociodemographic variables, establishing their predictive factors. Method: a cross-sectional study was conducted with a representative sample of 761 students (14.51 ± 1.63 years old) from 25 educational centers in a northern region of Spain. Body mass index, maximum oxygen uptake, health-related quality of life, self-esteem, hours of nightly sleep, adherence to the Mediterranean diet, physical activity engagement, academic performance, and different sociodemographic factors were analyzed for all participants. Results: the results determined that being a boy, being younger, sleeping fewer hours at night, and presenting a lower academic performance were predictors of suffering from obesity, while being younger and being a migrant were predictors of being overweight. On the other hand, lower physical activity engagement, poorer academic performance, being a migrant, and not practicing extracurricular sports activities were predictive factors of cardiorespiratory fitness in the risk zone. In addition, the environment for performing physical activity and socioeconomic level also showed associations with cardiorespiratory fitness. Conclusions: given the influence of body composition and cardiorespiratory fitness on the physical and psychosocial health of adolescents, promotion strategies are required that take into account the identified predictors, with special attention to promoting healthy lifestyles.

Physical Activity Is Associated With Lower Long-Term Incidence of Anxiety in a Population-Based, Large-Scale Study

Physical activity may prevent anxiety, but the importance of exercise intensity, sex-specific mechanisms, and duration of the effects remains largely unknown. We used an observational study design to follow 395,369 individuals for up to 21 years to investigate if participation in an ultralong-distance cross-country ski race (Vasaloppet, up to 90 km) was associated with a lower risk of developing anxiety. Skiers in the race and matched non-skiers from the general population were studied after participation in the race using the Swedish population and patient registries. Skiers (n = 197,685, median age 36 years, 38% women) had a significantly lower risk of developing anxiety during the follow-up compared to non-skiers (adjusted hazard ratio, HR 0.42). However, among women, higher physical performance (measured as the finishing time to complete the race, a proxy for higher exercise dose) was associated with an increased risk of anxiety compared to slower skiing women (HR 2.00). For men, the finishing time of the race did not significantly impact the risk of anxiety. Our results support the recommendations of engaging in physical activity to decrease the risk of anxiety in both men and women. The impact of physical performance level on the risk of anxiety requires further investigations among women.

The Mediating and Moderating Effects of Physical Fitness of the Relationship between Adherence to the Mediterranean Diet and Health-Related Quality of Life in University Students

The aim of this study was to estimate the relationship between the adherence to the Mediterranean diet (MD) and health-related quality of life (HRQoL) in university students and to assess whether this relationship is mediated or moderated by cardiorespiratory fitness (CRF) and handgrip strength. A cross-sectional study was performed involving 310 first-year Spanish university students. Adherence to the MD was evaluated with the 14-item Mediterranean Diet Adherence Screener (MEDAS), and the HRQoL was evaluated with the Short Form-12 (SF-12) questionnaire. CRF was assessed by the 20 m shuttle run test, and the handgrip strength was determined by dynamometry. ANCOVA models showed that participants with higher CRF and handgrip strength levels had significantly higher scores in the physical component summary (PCS) and mental component summary (MCS) of the SF-12 and in the MEDAS questionnaire than those with medium and low scores (p < 0.050). Additionally, the ANCOVA models showed that students with good adherence to the MD showed higher scores in the MCS of HRQoL than those with low adherence (p = 0.044, ES = 0.013), but these results did not appear for the PCS of HRQoL (p = 0.728, ES = 0.001). In the mediation analysis, it was found that CRF and handgrip strength acted as full mediators of the relationship between adherence to the MD and the MCS of HRQoL. In the moderation analysis, it was evidenced that CRF and handgrip strength did not act as moderators in the relationship between adherence to the MD and the MCS of HRQoL. In conclusion, adherence to the MD does not seem to have a direct effect on the MCS of HRQoL because this association seems to be fully mediated by CRF and handgrip strength.

Muscular and cardiorespiratory fitness are associated with health-related quality of life among young adult men

Background

Despite numerous studies providing evidence for positive effects of physical activity and physical fitness, evidence for association between physical fitness and health-related quality of life (HRQoL) in young adults is limited. The aim of the present cross-sectional study was to investigate the association of cardiorespiratory and muscular fitness with HRQoL from the perspective of its physical and mental components among young adult Finnish males.

Methods

The sample consisted of 754 men, with the mean age of 26 years (SD 6.7 years), who participated in the military refresher training. HRQoL was measured using the Finnish RAND 36-item health survey. Cardiorespiratory fitness was determined by a bicycle ergometer test, and muscular fitness by various tests measuring maximal strength and muscular endurance. Logistic regression modelling was used to compare low, moderate and high physical and mental component of HRQoL scores to the respective levels of muscular and cardiorespiratory fitness.

Results

The findings of the adjusted (age, educational level, marital status, employment status, smoking, use of alcohol and BMI) analysis showed that cardiorespiratory and muscular fitness are positively associated with both physical and mental components of HRQoL. In terms of the physical component of HRQoL, even a moderate fitness level was positively associated with better HRQoL. In terms of the mental component of HRQoL, the impact was seen only in the group with the highest fitness level.

Conclusions

The findings suggest a positive contribution of physical fitness to mental health and highlight the importance of both muscular and cardiorespiratory fitness in the promotion of HRQoL. Even lighter forms of physical activity that result in moderate physical fitness could contribute to the physical component of HRQoL. In terms of the mental component of HRQoL, higher levels of physical fitness may be needed to gain higher levels of HRQoL among young males.

Enhancement of hypothalamic-pituitary activity in male athletes: evidence of a novel hormonal mechanism of physical conditioning

BACKGROUND

Exercise is known to induce multiple beneficial conditioning processes. Conversely, although exercise may generate several hormonal effects, an intrinsic hormonal conditioning process has not been reported. In the Endocrine and Metabolic Responses on Overtraining Syndrome (EROS) study, we observed inherent and independent conditioning processes of the hypothalamic-pituitary axes in athletes. Our objective is to describe the theory of the novel hormonal conditioning mechanism using the findings from the EROS study.

METHODS

In this cross-sectional study, we selected 25 healthy athletes (ATL) and 12 non-physically active healthy controls (NPAC), 18-50 years old, males, with BMI 20-30 kg/m², with similar baseline characteristics, who underwent gold-standard exercise-independent tests: cosyntropin stimulation test (CST) and insulin tolerance test (ITT), to evaluate cortisol response to CST, and ACTH, cortisol, GH, and prolactin responses to an ITT.

RESULTS

Responses to ITT were significantly earlier and higher in ATL than NPAC for cortisol [Mean ± SD: 21.7 ± 3.1 vs 16.9 ± 4.1 μg/dL; p < 0.001], GH [Median (95% CI): 12.73 (1.1-38.1) vs 4.80 (0.33-27.36) μg/L; p = 0.015], and prolactin [24.3 (10.5-67.45) vs 10.50 (6.21-43.44) ng/mL; p = 0.002]. Cortisol response to CST was similar between ATL and NPAC. During ITT, cortisol, GH, and ACTH mean increase in ATL were 52.2, 265.2, and 18.6% higher than NPAC, respectively. Prolactin response was absent in NPAC, while present in ATL.

CONCLUSIONS

We found sufficient evidence to propose the existence of a diffuse enhancement of the hypothalamic-pituitary activity in athletes, not restricted to any axis, showing an intrinsic and independent process of "hormonal conditioning" in athletes, similar to those observed in the cardiovascular and neuromuscular systems. This novel conditioning process may be the missing link for understanding the improved responses observed in athletes to harmful situations, traumas, infections, inflammations, and psychiatric conditions.

The association between cardiorespiratory fitness and the incidence of common mental health disorders: A systematic review and meta-analysis

BACKGROUND

Physical activity is associated with a lower incidence of common mental health disorder, but less is known about the impact of cardiorespiratory fitness (CRF).

METHODS

In this review, we systematically evaluated the relationship between CRF and the incidence of common mental health disorders in prospective cohort studies. We systematically searched six major electronic databases from inception to 23rd of May 2019. We assessed study quality using the Newcastle-Ottawa scale.

RESULTS

We were able to pool the hazard ratios (HRs) and 95% confidence intervals (CIs) of four studies including at least 27,733,154 person-years of data. We found that low CRF (HR = 1.47, [95% CI 1.23 - 1.76] p < 0.001 I2 = 85.1) and medium CRF (HR = 1.23, [95% CI 1.09 - 1.38] p < 0.001 I2 = 87.20) CRF are associated with a 47% and 23% greater risk of a common mental health disorders respectively, compared with high CRF. We found evidence to suggest a dose-response relationship between CRF and the risk of common mental health disorders.

LIMITATIONS

We were only able to identify a small number of eligible studies from our search and heterogeneity was substantial in the subsequent meta-analysis.

CONCLUSIONS

Our findings indicate that there is a longitudinal association between CRF levels and the risk of a common mental health disorder. CRF levels could be useful for identifying and preventing common mental health disorders at a population-level.

Cross-sectional and longitudinal association of non-exercise estimated cardiorespiratory fitness with depression and anxiety in the general population: The HUNT study

BACKGROUND

Cardiorespiratory fitness may help to prevent depression and anxiety. A paucity of literature has considered the relationship between cardiorespiratory fitness (CRF) and the incidence of depression and anxiety. The objective of this study was to investigate cross-sectional and longitudinal associations of estimated cardiorespiratory fitness (CRF) with depression and anxiety.

METHODS

This study included middle-aged and older participants from the second (HUNT 2, 1995-1997) and third (HUNT3, 2006-2008) survery of the Nord-Trøndelag Health Study (HUNT). Baseline non-exercise estimated CRF (eCRF) was determined using standardized algorithms. Depression and anxiety were measured using the Hospital Anxiety and Depression Scale. Logistic regression models were used to evaluate the cross-sectional and longitudinal associations between eCRF and depression and anxiety.

RESULTS

In cross-sectional adjusted analysis including those who participated in HUNT2 (n = 26,615 mean age 55.7 years), those with medium and high level of eCRF had 21% (OR, 0.79; 95% CI, 0.71-0.89) and 26% (OR, 0.74; 95% CI, 0.66-0.83) lower odds of depression compared to those with low eCRF level, respectively. Longitudinal analysis including those who participated in both HUNT2 and HUNT3 (n = 14,020 mean age 52.2 years) found that medium and level of eCRF was associated with 22% (OR, 0.78; 95% CI, 0.64-0.96) and 19% (OR, 0.81; 95% CI, 0.66-0.99) lower odds of depression compared to those with low eCRF level, respectively. CRF was not associated with anxiety, either cross-sectionally or longitudinally.

CONCLUSION

Our data suggest that a medium and high level of eCRF during late middle age is cross-sectionally and prospectively associated with lower odds of depression. However, our data do not support that eCRF is associated with anxiety. Further studies are warranted to conclude a causal relationship between eCRF and depression.

Inter-correlations Among Clinical, Metabolic, and Biochemical Parameters and Their Predictive Value in Healthy and Overtrained Male Athletes: The EROS-CORRELATIONS Study

Objectives: The Endocrine and Metabolic Responses on Overtraining Syndrome (EROS) study identified multiple hormonal and metabolic conditioning processes in athletes, and underlying mechanisms and biomarkers of overtraining syndrome (OTS). The present study's objective was to reveal independent predictors and linear correlations among the parameters evaluated in the EROS study to predict clinical, metabolic, and biochemical behaviors in healthy and OTS-affected male athletes. Methods: We used multivariate linear regression and linear correlation to analyze possible combinations of the 38 parameters evaluated in the EROS study that revealed significant differences between healthy and OTS-affected athletes. Results: The testosterone-to-estradiol (T:E) ratio predicted the measured-to-predicted basal metabolic rate (BMR) ratio; the T:E ratio and total testosterone level were inversely predicted by fat mass and estradiol was not predicted by any of the non-modifiable parameters. Early and late growth hormone, cortisol, and prolactin responses to an insulin tolerance test (ITT) were strongly correlated. Hormonal responses to the ITT were positively correlated with fat oxidation, predicted-to-measured BMR ratio, muscle mass, and vigor, and inversely correlated with fat mass and fatigue. Salivary cortisol 30 min after awakening and the T:E ratio were inversely correlated with fatigue. Tension was inversely correlated with libido and directly correlated with body fat. The predicted-to-measured BMR ratio was correlated with muscle mass and body water, while fat oxidation was directly correlated with muscle mass and inversely correlated with fat mass. Muscle mass was directly correlated with body water, and extracellular water was directly correlated with body fat and inversely correlated with body water and muscle mass. Conclusions: Hypothalamic-pituitary responses to stimulation were diffuse and indistinguishable between the different axes. A late hormonal response to stimulation, increased cortisol after awakening, and the T:E ratio were correlated with vigor and fatigue. The T:E ratio was also correlated with body metabolism and composition, testosterone was predicted by fat mass, and estradiol predicted anger. Hydration status was inversely correlated with edema, and inter-correlations were found among fat oxidation, hydration, and body fat.

An Internet-based survey of the dance fitness program OULA

Background:

OULA is a high-energy dance workout to top 40 hits that is inspired by yoga and non-impact aerobics. Created in Missoula, Montana, the program has been gaining national and international popularity. To understand the demographic composition, reasons for attending OULA, and experiences with depression/anxiety, we conducted an Internet-based survey.

Methods:

A pilot descriptive cross-sectional Internet-based survey was created in Qualtrics and distributed through social media and flyers.

Results:

The 38-item survey received responses from 302 participants. Current OULA participants chose “exercise” as the primary reason for attending (40.2%, 95% confidence interval: 33.3–48.2), followed by “stress relief/improve mood” (28.8%, 95% confidence interval: 23.0–35.6). Participants listed “stress relief/improve mood” as the most common secondary (35.6%, 95% confidence interval: 29.0–43.2) and tertiary (38.6%, 95% confidence interval: 31.7–46.7) reason for attending OULA. A majority of the participants said that OULA makes them feel like part of a community (93.2%, 95% confidence interval: 82.5–105.1) and increases their energy outside of class (80.1%, 95% confidence interval: 70.2–91.1). In our sample, 12.5% (95% confidence interval: 8.8–17.1) and 9.0% (95% confidence interval: 5.9–12.9) were currently taking antidepressants and anxiolytics, respectively.

Conclusion:

These results suggest that current OULA participants are already using the program to relieve stress or improve mood. Further research should be conducted to understand the relationship between OULA and depression/anxiety.