Physical activity in adolescents with psychiatric disorders and in the general population

Implementing exercise recommendations into clinical practice-new findings from mental health professionals' and patients' perspectives in a university psychiatric setting

Introduction

To date, concrete recommendations for physical activity in psychiatric treatments are limited. Thus, we evaluated knowledge, barriers and beliefs associated with exercise prescription of mental health professionals (MHP) to people with mental illnesses. We aimed to identify patients' barriers to exercise participation and to work out options addressing these barriers.

Methods

In our cross-sectional and questionnaire-based investigation, we recruited medical, nursing and therapeutic staff and patients of a psychiatric clinic by email and personal contact. Questionnaires contained the German versions of The Exercise in Mental Illness Questionnaire (EMIQ-G) and the International Physical Activity Questionnaires (IPAQ).

Results

We included 100 MHP and 100 patients. MHP had significantly more knowledge regarding positive effects of exercise on general health than patients. Exercise was prescribed mostly (48.4%) or always (37.9%) by MHP. The data showed missing education in exercise prescriptions and different recommendation behavior. Male patients seemed to experience exercise more often as a positive distraction and had lower physical health barriers than females.

Discussion

Physical activity needs to be more integrated in psychiatric treatments. Some strategies as educating MHP and patients regarding potential benefits of exercise via psychoeducative brochures and adapting recommendations to individual symptoms could improve exercise behavior in psychiatric patients.

Feasibility of a physical activity intervention for children and adolescents with anxiety and depression

BACKGROUND

Physical activity is identified as a key modifiable factor towards good short- and long-term mental health and has shown positive effects on anxiety and depression in children and adolescents. However, physical activity-based interventions are not a part of standard mental health care and evidence on the effect of such interventions is still lacking. A transdiagnostic, physical activity-based intervention was developed as a supplement to routine clinical care for youth in specialized child and adolescent mental health services.

METHODS

/design. The feasibility of the physical activity intervention (Confident, Active, and Happy Youth) was evaluated in an open-label study by assessing the recruitment process, acceptability, intervention suitability, contentment, and preliminary intervention effects in the form of youth and parent-rated anxiety and depressive symptoms. Physical activity levels were objectively measured using Actigraph™ physical activity sensors, and progression to a definitive study was evaluated in accordance with a priori criteria.

RESULTS

In total 21 of 25 eligible youth consented to participate, two dropped out of the intervention and 19 completed (76% of eligible participants). The retention rate among consenting participants was 89% and mean attendance to sessions was 83%. The suitability of the intervention was rated as good by the youth and their parents, and intervention contentment was rated high. Changes in youth and parent-rated symptom measures following the intervention were negligible, except for parent-rated anxiety symptoms assessed at 10-month follow-up. Accelerometer data indicated lower levels of moderate to vigorous activity during sessions than intended. No adverse effects were noted.

CONCLUSION

This feasibility study met the pre-determined progression criteria to a definitive study. Thus, a larger trial with longer follow-up should be conducted to explore the effect of the intervention.

TRIAL REGISTRATION

ClnicalTrials.gov, NCT05049759. Retrospectively registered, 20.09.2021.

Effects of game-based physical education program on enjoyment in children and adolescents: a systematic review and meta-analysis

OBJECTIVE

The objective of this study was to conduct a systematic review to summarize and assess the advancements lately made on the enjoyable impacts of game-based physical education interventions on children and adolescents. Additionally, it attempted to identify the effects and variables influencing the enjoyable outcomes of children and adolescents' engagement in physical education games, through meta-analysis.

METHODS

This study involves a comprehensive search of different databases like Web of Science, PubMed, Embase, EBSCOhost, Cochrane, and Scopus. Specific criteria are established for the selection process to make sure the relevant literature included. The quality assessment of the included researches is conducted based on the guidelines outlined in the Cochrane 5.1 handbook. Review Manager 5.3 software is employed to synthesis the effect sizes. Additionally, bias is assessed using funnel plots, and to identify potential sources of heterogeneity, subgroup analyses are performed.

RESULTS

A total of 1907 academic papers, out of which 2 articles were identified via other data sources. The present study examined the impact of a pedagogical intervention involving physical education games on the enjoyment experienced by children and adolescents. The results indicated a significant positive effect (MD = 0.53, 95%CI:[0.27,0.79], P < 0.05) of this intervention on enjoyment. Subgroup analyses further revealed that both boys (MD = 0.31, 95%CI:[0.13,0.50], P < 0.05) and girls (MD = 0.28, 95%CI:[0.05,0.51], P < 0.05) experienced increased pleasure compared to traditional physical education. Additionally, children under 12 years of age (MD = 0.41, 95%CI:[0.17,0.64], P < 0.05) benefited from sessions lasting at least 30 minutes or more per session (MD = 0.40, 95%CI:[0.19,0.60], P < 0.05), occurring 1 to 3 times per week (MD = 0.28, 95%CI:[0.16,0.40], P < 0.05), and lasting for more than 3 weeks (MD = 0.81, 95%CI:[0.29,1.34], P < 0.05). These findings suggest that the implementation of physical education games can be an effective approach to teaching this subject.

CONCLUSIONS

1) Interventions using physical games have been shown to yield beneficial outcomes in terms of enhancing the enjoyment experienced by children and adolescents. 2) The effectiveness of treatments aimed at promoting enjoyment among children and adolescents is influenced by several aspects, including gender, age, duration and frequency of physical activity, as well as the specific cycle of activity used.

Playing for more than winning: Exploring sports participation, physical activity, and belongingness and their relationship with patterns of adolescent substance use and mental health

BACKGROUND

Promoting adolescent sports participation and physical activity may be effective low-barrier prevention strategies for co-occurring adolescent substance use (SU) and mental health symptoms (MH). The objectives of this study were to: 1) explore associations between profiles of SU/MH and sports participation; and 2) determine whether physical activity and belongingness account for these associations.

METHODS

Data came from a representative sample of 11,994 grade 9-12 Ontarian students (ages ~14-18) previously grouped into five SU/MH profiles based on patterns of use and symptoms. A series of multinomial logistic regressions, adjusted for socio-demographics and school clustering, were used to predict the risks of students belonging to SU/MH profiles based on: 1) school sports participation (>=weekly), 2) sports and physical activity (>=60minutes; 0-7 days), and 3) sports, physical activity, and school belongingness.

RESULTS

Greater school sports participation, physical activity, and belongingness were each associated with reduced risks of belonging to most profiles with elevations in SU and/or MH symptoms relative to the low SU/MH profile (Relative Risk Ratios: sports=0.62-0.87, physical activity=0.78-0.98, belonging=0.75-0.83). Frequency of physical activity accounted for ~32-60% of the associations between sports and SU/MH profiles, while school belongingness accounted for the remaining associations. Physical activity and belongingness remained independently associated with SU/MH profiles.

CONCLUSIONS

Findings suggest possible indirect associations between school sports participation and SU/MH profiles through physical activity and school belongingness, which may be promising prevention targets that have independent associations over and above sports. School sports participation may be one of a number of ways to achieve these goals.

Interpersonal violence and recurrent headache among adolescents with a history of psychiatric problems

BACKGROUND

Interpersonal violence (IPV) is found to be associated with mental health problems and pain disorders such as headache among children and adolescents. It is well-known that adolescents in need of mental health services have experienced IPV more often than adolescents in the general population. However, there has not been much focus on pain conditions in child and adolescent psychiatric populations.

METHODS

Data from the current study are based on a 3-year follow-up of the CAP-survey, which is a study of adolescents in the child and adolescent psychiatric unit population of St. Olavs Hospital (Trondheim University Hospital). The baseline study was conducted between 2009 and 2011, with 717 participants between 13 and 18 years. All participants were enrolled, or newly referred to the child and adolescent psychiatric clinic. At follow-up, 570 participants completed questionnaire, and 550 completed a diagnostic interview. The participants were aged 16-21 years (mean age 18.6 years).

RESULTS

A third of the adolescents reported frequent headaches (weekly or daily). Adolescents with more severe mental problems were more likely to experience frequent headaches. Adolescents exposed to unpleasant sexual acts or bullying, reported more frequent headaches than non-exposed participants. Participants exposed to three or more types of IPV seemed to be at particularly high risk of experiencing frequent headache.

CONCLUSIONS

Both experiences of interpersonal violence and headache are common in this clinical psychiatric population. Clinicians should assess for headache disorders in addition to psychiatric and trauma assessment and provide need-based treatment to enhance chance of recovery among adolescents in mental health services.

[Opportunities in Differentiated School Sports Exemption - Results of An Online-Survey and Review of the Literature]

BACKGROUND

Physical education and sports participation in school play a major role in overall activity of children and adolescents. A differentiated school sports exemption (DSE) allows sports participation adapted to the individual's ability.

METHOD

Online-survey among physicians (2019) and physical education (PE) teachers (in two waves, 2017 and 2019), on their opinion towards the concept of DSE with respect to professional and demographic parameters. Answers were scaled on a 6-point Likert scale. Means and 95% confidence intervals (95%-CI) were calculated.

RESULTS

Complete questionnaires of 97 physicians and 280 teachers were included. A mean of 10,3% (95%-CI: 9,5-11,1%) of students, did not participate in PE class. In most cases, students were excused directly by their parents without consulting a physician. Most frequent reasons for exemption were missing sports gear (62%), common colds (54%), or acute injuries (50%). Chronic disease or disability was rare (8%). Most teachers did not feel well prepared to deal with children with chronic diseases or disabilities in PE class. Many physicians (24%) had never considered DSE. However, the concept was well accepted among both physicians and teachers. It was considered more practicable than exemption from being marked.

DISCUSSION

According to participants, DSE is expedient and feasible. As a secondary option, students with chronic disease or disability may be exempted from being marked in PE class by their physician.

CONCLUSION

The concept of DSE was widely accepted, but rarely used. It can be applied in various scenarios. In order to improve sports participation, a national standardized procedure should to be implemented.

Exploratory examination of the association between physical-mental multimorbidity and physical activity in children

Children with physical illnesses often experience co-occurring mental illness (known as multimorbidity; MM) and it is currently unknown if MM is associated with physical activity (PA) and if the association differs between internalizing and externalizing disorders. Therefore, the aim of this study was to examine the association between MM and PA. Baseline data from the Multimorbidity in Children and Youth Across the Life Course (MY LIFE) cohort was used. MY LIFE is an ongoing prospective study that follows children ages 2 to 16 years with a chronic physical illness and measures PA using accelerometry and mental illness using the Mini International Neuropsychiatric Interview for Children and Adolescents. 140 children (53.2%) provided valid accelerometer data. Children with internalizing disorders recorded less light (B = -5.87), moderate (B = -1.82), and vigorous PA (B = -1.93) and fewer days meeting PA guidelines [Exp(B) = 0.73] and those with externalizing disorders recorded more light (B = 4.85), moderate (B = 1.78), and vigorous PA (B = 2.41) and more days meeting PA guidelines [Exp(B) = 1.06]. However, only the association between internalizing disorder and days meeting PA guidelines was statistically significant. This study provides preliminary evidence that children with MM may accumulate less PA depending on the type of mental illness they experience.

Physical exercise, depression, and anxiety in 2190 affective disorder subjects

BACKGROUND

This study evaluated associations of PE with symptomatic status in mood and anxiety disorder subjects, and considered many other associated factors so as to expand on comparable previous studies.

METHODS

Consenting adults at a mood disorder center were assessed for associations of PE frequency ([never, past only, ≤once/week] vs. regularly at 2-3- or >3-times/week) with standard psychometric measures of depression and anxiety symptoms, selected demographic, clinical factors, using bivariate and multivariate methods.

RESULTS

Of 2190 subjects (58.8% women; mean age 42.6 years; 44.8% with major depressive, 40.6% bipolar, and 14.6% anxiety disorders), 22.5% currently engaged in regular PE. Such engagement was associated with lower morbidity ratings, youth, male sex, being unmarried, more education, higher socio-economic status (SES), less religious practice, less early abuse, younger age at illness onset and at intake, fewer years ill, lower BMI, fewer siblings, hyperthymic temperament, less time depressed before intake, and living at higher population density. Greater PE-frequency was associated with lower ratings of depression (but not anxiety), male sex, younger age, and lower BMI. Factors independently associated with PE in multivariate modeling ranked by significance: older age at intake ≥ lower BMI > more education > higher SES > male sex.

LIMITATIONS

PE assessment did not include type, intensity or duration. Some information provided may be subject to recall bias, though it should not affect comparisons among subjects.

CONCLUSION

Regularly repeated PE again appeared to be beneficial for patients with depression or anxiety and should be included in their treatment interventions.

Correlates of Moderate-to-Vigorous Physical Activity in Children With Physical Illness and Physical-Mental Multimorbidity

This study measured physical activity (PA) and explored its correlates among children with multimorbidity (co-occurring chronic physical and mental illness; MM) versus those with chronic physical illness only (PI). This study used baseline data from the Multimorbidity in Children and Youth Across the Life Course (MY LIFE) study, an on-going cohort study following 263 children with a PI 2 to 16 years of age (mean age: 9.8 years, SD = 4.0; 47.7% female). PA was measured using accelerometry, and demographic and psychosocial variables were collected using questionnaires. Of the 55 children with MM and the 85 with PI with valid accelerometer data, 38.1% and 41.2%, respectively, met average daily PA guidelines. Correlates of moderate-to-physical PA (MVPA) among children with MM were age, ρ(53) = -0.45, p = .001, body mass index (BMI), ρ(48) = -0.28, p = .04, self-perceived behavioral conduct, ρ(24) = -0.45, p = .02, physical health-related quality of life, ρ(51) = 0.56, p < .001, and peer support, ρ(52) = 0.27, p = .04. Correlates of MVPA among children with PI were age, ρ(83) = -0.40, p < .001, sex, ρ(83) = -0.26, p = .01, self-perceived social competence, ρ(31) = 0.42, p = .02, self-perceived athletic competence, ρ(31) = 0.48, p = .005, physical health-related quality of life, ρ(83) = 0.34, p = .001, participation in community sport, ρ(31) = 0.41, p = .02, and family functioning, ρ(83) = 0.26, p = .02. These results demonstrate that children with PI and MM are insufficiently active and their PA is correlated with demographic and psychosocial factors.

Development and feasibility testing of a physical activity intervention for youth with anxiety and depression: a study protocol

Background

Anxiety and depressive disorders in children and adolescents are highly prevalent and account for more than half of all youth psychiatric disorders. Left untreated, anxiety, and depression lead to numerous detrimental outcomes, including reduced quality of life, psychiatric, and somatic comorbidity and even reduced lifespan. This puts a large strain on child and adolescent mental healthcare services (CAMHS) to provide effective treatments. However, even when provided the best evidence-based treatment, between 40–50% of patients continue to report significant symptom burdens. Thus, there is an immediate need for supplemental and/or new treatment approaches. Physical activity as a supplementary treatment may be such an approach. However, research investigating this approach within this population is scant. This protocol paper describes the development and feasibility trial of a physical activity-based intervention targeting anxiety and depressive symptoms in youth treated in CAMHS.

Methods/design

The study is based on the UK Medical Council Research Framework (MRC) for developing and evaluating complex interventions. Feasibility and acceptability of the physical activity intervention (confident, active, and happy youth) will be evaluated in an uncontrolled open-label trial using qualitative and quantitative data. Twenty youths with anxiety and/or depressive symptoms will be recruited. Acceptability of assessment procedures, the intervention, and perceived benefits and barriers to participation will be assessed, and qualitative interviews with participants, caregivers, and referring specialists will explore contextual and practical factors associated with intervention delivery. Physical activity will be measured using the Actigraph GT3X+ monitor at baseline, and post-intervention and change in anxiety and depression will be assessed.

Discussion

This study will contribute to the development of supplementary physical treatment interventions for youth with anxiety and depression in contact with CAMHS. The goal is to examine new avenues of treatment that ultimately may improve upon current treatment outcomes of anxiety and depression. This work will be in preparation for a future definitive randomized controlled trial (RCT) of this approach, in line with the MRC Framework.

Trial registration

ClnicalTrials.gov, NCT05049759. Registered on August 19, 2021. Retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-01010-6.

Bi-directional relationships between physical activity and mental health among a large sample of Canadian youth: a sex-stratified analysis of students in the COMPASS study

Objective

The aim of this research was to examine the bidirectional association between self-reported symptoms of mental disorder and physical activity among a large sample of Canadian secondary school students over time.

Methods

Linked survey data were obtained from 28,567 grade 9 to 12 students across Canada participating in two waves of the COMPASS Study (2017–18; 2018–19). Autoregressive cross-lagged models were run to examine the reciprocal relationships between self-reported moderate-to-vigorous physical activity (MVPA) and symptoms of depression (CESD-10) and anxiety (GAD-7). Models were stratified by gender, and accounted for grade, ethno-racial identity, and school-level clustering.

Results

Autoregressive associations show that neither symptoms of anxiety nor depression, at baseline, were predictive of mean MVPA at follow-up – consistent for the full sample and among both males and females. Higher MVPA among males at baseline was associated with lower symptoms of both anxiety (β = − 0.03, p = 0.002) and depression (β = − 0.05, p < 0.001) at follow-up. However, among females, higher MVPA at baseline was associated with greater symptoms of anxiety (β = 0.03, p < 0.001), but not symptoms of depression (β = 0.01, p = 0.073), at follow-up.

Conclusion

In our large sample of Canadian secondary school students, associations between physical activity and symptoms of mental disorder were not bi-directional, and these relationships differed in males and females. This study illustrates the complex nature of the relationship between physical activity and symptoms of mental disorder among youth. While results support the benefits of promoting physical activity among males to prevent or manage internalizing symptoms, the relationship among females warrants further investigation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01201-z.

Levels of physical activity and barriers to sport participation in young people with gender dysphoria

OBJECTIVES

To determine the levels of physical activity (PA) in young people with gender dysphoria (GD) and help identify factors which deter participation.

METHODS

Fifty-six young people who attended paediatric endocrinology because of GD, June to October 2019, and were on treatment with gonadotrophin-releasing hormone (GnRH) analogue were approached to participate in a survey.

RESULTS

A total of 55 young people (98%) responded to the survey. Thirty-eight (69%) participated in PA for >1 h/week. Thirty-two (58%) reported high motivation level for exercise. Those had median age of 15.9 years (10.7, 18.7) at the time of survey, and 13.6 years (9.7, 17.6) at start of GnRH analogue compared to 16.7 years (13.9, 18.5) (p, 0.047) and 15.4 years (11.2, 18.0) (p, 0.009) of the 23 (42%) who reported low motivation. Forty-one (74.5%) reported barriers when accessing PA, such as not being as good as others (75%), revealing sports clothing (73%) and not satisfied with body image (47%). Those were older (16.4 years [10.9, 18.7] vs. 14.7 years [10.7, 18.4] [p, 0.011]) at the time of survey and at start of GnRH analogue (14.9 years [9.7, 18.0] vs. 12.5 years [10.6, 15.2] [p, 0.0001]) than those 14 (25.5%) who reported facing no barriers. Twelve (85.7%) of those reporting no barriers stated high motivation levels compared to 20 (48.8%) of those reporting barriers (p, 0.026).

CONCLUSIONS

Strategies aimed at improving participation are twofold: first to improve motivation, especially in post-pubertal young people, and secondly to achieve societal change to help eliminate barriers.

Adolescents' Experiences of Facilitators for and Barriers to Maintaining Exercise 12 Months after a Group-Based Intervention for Depression

Exercise can improve health among adolescents with depression. Understanding facilitators for and barriers to maintaining exercise among adolescents with depression may increase adherence to exercise and consequently improve health. The aim was to explore adolescents’ experiences of facilitators for and barriers to maintaining exercise after a group-based exercise intervention for depression. Interviews (n = 14) were conducted 12 months after the exercise intervention. A qualitative content analysis was used to extract facilitators and barriers. Facilitators for maintaining exercise among adolescents with depression were (1) greater self-esteem by having companionship while exercising and by achieving exercise results and (2) having a supportive environment in terms of accessibility and coaching. Barriers to maintaining exercise were (1) disease burden due to fatigue, social anxiety, and a lack of drive, and (2) lack of a supportive environment including a lack of social support, as well as structural support. In conclusion, facilitating enhanced self-esteem and continuous support for exercising are important for adolescents with depression to maintain exercise. The disease burden of depression is a substantial barrier that needs to be considered to maintain exercise. The findings can contribute to the development of services that promote and coordinate exercise as a treatment among adolescents with depression.

Sociodemographic Correlates and Mental Health Comorbidities in Adolescents With Social Anxiety: The Young-HUNT3 Study, Norway

Social anxiety is highly prevalent in adolescents and is often associated with great individual suffering and functional impairment. Psychiatric comorbidity is common and further adds to this burden. The purposes of this study were: (1) to describe the occurrence of diagnosed and self-reported social anxiety among 8,199 Norwegian adolescents aged 13–19 years who participated in the population-based Young-HUNT3 study (2006–2008); (2) to examine associations between sociodemographic characteristics and different subgroups of social anxiety; and (3) to describe the psychiatric health comorbidities among adolescents diagnosed with social anxiety disorder (SAD). In total, 388 (5.9%) of the adolescents screened positive for SAD and were invited into a diagnostic interview, performed by professional nurses, using Anxiety Disorders Interview Schedule for DSM IV: child version (ADIS-C) (response rate = 54.6%). A SAD diagnosis was indicated in 106 individuals (50% of the interview subjects), and more than two-thirds of the adolescents diagnosed with SAD had one or more comorbid psychiatric disorders. Higher mean scores of self-reported social anxiety symptoms, poor self-rated health, sleep problems, poor family economic situation, low physical activity, and having sought professional help within the last year were associated with higher odds of being in the screening positive subgroup. Screening positive subjects who did not meet for a diagnostic interview did not differ notably from the rest of the screening positive group in terms of these sociodemographic characteristics. Based on our results and the fact that individuals with social anxiety often fear interview situations, the use of ADIS-C, screening questions and self-reports seem to be sufficient when aiming to identify epidemiologically representative cohorts of adolescents at risk of social anxiety.

Low sports participation is associated with withdrawn and depressed symptoms in urban, school-age children

BACKGROUND

The association between sports participation and mental health has not been studied in primary care samples of school-age children, nor in underrepresented minority children. We assessed the relationship between number of sports played and psychiatric symptoms in children ages 6-11 at well-child visits in an urban clinic.

METHODS

Guardians of 206 children (85% Latinx) ages 6-11 completed Child Behavior Checklists (CBCL) in Spanish (66.5%) or English at well-child visits at an urban community health center. We performed linear regression between number of sports played and individual CBCL syndrome scores, and multiple logistic regression with normal (T-score <60) vs. elevated (T-score ≥60) CBCL syndrome scale score as the outcome. We conducted bivariate, multiple logistic regression, and linear regression analyses between low (1 or fewer) vs. high (2 or more) sports participators and subscales of interest.

RESULTS

Fewer sports played was associated with higher Withdrawn/Depressed CBCL syndrome scale T-scores (p = 0.019), but not with other CBCL syndrome scale scores nor number of syndrome scale elevations (p = 0.638). Low participators had higher odds of an elevated Withdrawn/Depressed T-score (p = 0.033) than high participators.

LIMITATIONS

Our dataset did not contain certain details about sports played, nor information about income and insurance, and our results may not generalize to other populations.

CONCLUSIONS

Playing fewer sports is associated with higher withdrawn/depressed symptoms in urban, predominantly Latinx, school-age children. Therefore, urban school-age children with low sports participation may be at risk for depression, and sports participation might protect against depressive symptoms in childhood.

Influence of Organized vs Non Organized Physical Activity on School Adaptation Behavior

It is now well-established that physical activity has positive effects on both physical and mental health. However, the influence of organized physical activity (i.e., programs controlled and supervised by a trainer) on school adaptive behavior of adolescents with disabilities and/or behavioral disorders remains unclear. School behavior adaptation involves the ability to learn, conform to school norms and manage school activities without major behavior conflicts. A cross-sectional study was conducted to test the differences between organized physical activity and non-organized physical activity in an after school program. Eighty Romanian adolescents were recruited and allocated to three groups: (a) with disabilities [Ds; N = 17, M_age = 14.55 years (SD = 1.16), 12 males and 5 females], (b) with conduct disorders [CDs, N = 21, M_age = 14.52 years (SD = 1.11) 16 males and 5 females], and (c) participants who had not shown signs of conduct disorders or disabilities [as a control group; N = 42, M_age = 14.2 years (SD = 0.46) 20 males and 22 females]. Personality traits, school behavior, and sensorimotor coordination were assessed by using the Eysenck personality questionnaire—junior scale, school in-adaptability questionnaire scale, and Vienna Test System Sport (SMK—sensorimotor coordination test) respectively. Multivariate analysis of variance MANOVA (3 × 3) and discriminant analysis were used to examine differences between the psychological and sensorimotor coordination outcomes across three groups and three types of physical activity context: (a) organized physical activity, (b) non-organized physical activity, and (c) no physical activity. The findings indicate that not participating in an organized physical activity program results in a reduced level of physical mobility and consequently is associated with maladaptive social and psychological outcomes. Thus, we argued that attending in an organized physical activity program is more beneficial for participants with disabilities and/or behavior disorders, due to an increase in the probability of school integration and development of their motor skills. Clearly more research is needed in order to investigate these effects in neurophysiological levels.

The importance of social factors in the association between physical activity and depression in children

BACKGROUND

Physical activity is associated with reduced depression in youth and adults. However, our understanding of how different aspects of youth activities-specifically, the degree to which they are social, team-oriented, and physical-relate to mental health in children is less clear.

METHODS

Here we use a data-driven approach to characterize the degree to which physical and non-physical youth activities are social and team-oriented. We then examine the relationship between depressive symptoms and participation in different clusters of youth activities using mixed effect models and causal mediation analyses in 11,875 children from the Adolescent Brain Cognitive Development (ABCD) Study. We test our hypotheses in an original sample (n = 4520, NDA release 1.1) and replication sample of participants (n = 7355, NDA release 2.0.1).

RESULTS

We show and replicate that social-physical activities are associated with lower depressive symptoms. Next, we demonstrate that social connections, measured by number of close friends, partially mediate the association between social-physical activities and lower depressive symptoms.

CONCLUSIONS

Our results provide a rubric for using data-driven techniques to investigate different aspects of youth activities and highlight the social dynamics of physical activities as a possible protective factor against depression in childhood.

Changes in Motor Skill Proficiency After Equine-Assisted Activities and Brain-Building Tasks in Youth With Neurodevelopmental Disorders

There is a lack of current research to support the efficacy of a combination of equine-assisted activities (EAA) and brain building activities to influence motor skill competencies in youth with neurodevelopmental disorders (ND). The primary objective of this study was to quantify changes in motor skill proficiency before and after 8 weeks of EAA and brain-building activities in youth with ND. A secondary objective was to quantify changes in motor skill proficiency before and after 1 year of EAA and brain-building activities in youth with ND. Twenty-five youth completed the same 32-week protocol that was separated into 4, 8-week blocks, in the following order: (1) control; (2) EAA-only; (3) washout; (4) GaitWay block (EAA and brain building activities). Before and after each block, motor skills were assessed using the Short Form of the Bruininks-Oseretsky Test of Motor Proficiency-Version 2 (BOT-2). Seven youth continued with the GaitWay intervention for one additional year, and the BOT-2 Short Form was also administered following this intervention. A repeated-measures analysis-of-variance was performed to compare BOT-2 subtest and overall scores between interventions with a significance of 0.05. Manual dexterity was higher at Post-Washout [3.3 (2.4)] vs. Pre-Control [2.2 (2.1); p = 0.018] and Post-Control [2.6 (2.0); p = 0.024], and at Post-GaitWay vs. Pre-Control [3.2 (2.4) vs. 2.2 (2.1); p = 0.037]. Upper-limb coordination was higher at Post-GaitWay vs. Post-Control [6.0 (4.1) vs. 3.9 (3.8); p = 0.050]. When compared to Pre-Control [3.2 (3.0)], strength was higher at Post-EAA [4.9 (3.5); p = 0.028] and at Post-GaitWay [5.2 (2.9); p = 0.015]. Overall scores were higher at Post-GaitWay [39.1 (22.2)] when compared to Pre-Control [32.4 (21.6); p = 0.003] and Post-Control [32.5 (21.9); p = 0.009]. Additionally, motor skills were maintained for 1 year following the Post-GaitWay testing session among seven participants. This is the first known study to include and demonstrate the short-term and long-term effects of a combination of EAA and brain building activities with motor proficiency in youth with ND.

Clinical Trial Registration: Motor Skill Proficiency After Equine-Assisted Activities and Brain-building Tasks; www.ClinicalTrials.gov, identifier: NCT04158960.

Improving Mood with Physical ACTivity (IMPACT) trial: a cluster randomised controlled trial to determine the effectiveness of a brief physical activity behaviour change intervention on depressive symptoms in young people, compared with psychoeducation, in addition to routine clinical care within youth mental health services-a protocol study

INTRODUCTION

Depression is highly prevalent and the leading contributor to the burden of disease in young people worldwide, making it an ongoing priority for early intervention. As the current evidence-based interventions of medication and psychological therapy are only modestly effective, there is an urgent need for additional treatment strategies. This paper describes the rationale of the Improving Mood with Physical ACTivity (IMPACT) trial. The primary aim of the IMPACT trial is to determine the effectiveness of a physical activity intervention compared with psychoeducation, in addition to routine clinical care, on depressive symptoms in young people. Additional aims are to evaluate the intervention effects on anxiety and functional outcomes and examine whether changes in physical activity mediate improvements in depressive symptoms.

METHODS AND ANALYSIS

The study is being conducted in six youth mental health services across Australia and is using a parallel-group, two-arm, cluster randomised controlled trial design, with randomisation occurring at the clinician level. Participants aged between 12 years and 25 years with moderate to severe levels of depression are randomised to receive, in addition to routine clinical care, either: (1) a physical activity behaviour change intervention or (2) psychoeducation about physical activity. The primary outcome will be change in the Quick Inventory of Depressive Symptomatology, with assessments occurring at baseline, postintervention (end-point) and 6-month follow-up from end-point. Secondary outcome measures will address additional clinical outcomes, functioning and quality of life. IMPACT is to be conducted between May 2014 and December 2019.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the University of Melbourne Human Research Ethics Committee on 8 June 2014 (HREC 1442228). Trial findings will be published in peer-reviewed journals and presented at conferences. Key messages will also be disseminated by the youth mental health services organisation (headspace National Youth Mental Health Foundation).

TRIAL REGISTRATION NUMBER

ACTRN12614000772640.

Increasing physical activity and healthy diet in outpatients with mental disorders: a randomized-controlled evaluation of two psychological interventions

INTRODUCTION

While physical activity (PA) can play an important role in the treatment of mental disorders (MD), large proportions of patients with MD do not meet PA recommendations. The aim of this trial was to evaluate whether structured psychological intervention (MoVo-LISA) is effective in helping outpatients with MD to increase their level of PA. As active control group (CG) we modified MoVo-LISA to target healthy diet behavior.

METHODS

N = 83 outpatients with MD (F1-F4) were randomized to the two conditions. PA (self-report and accelerometry), dietary behavior, social-cognitive determinants of health behavior change, psychiatric symptoms and health-related quality of life were assessed at baseline, 1 and 12 weeks after the intervention.

RESULTS

Significant time*group interaction effects for objectively measured PA, dietary behavior and fruit and vegetable consumption indicated differential effects of the interventions on these outcomes. PA increased in the MoVo-LISA group (IG) from baseline to follow-up while it decreased in CG. IG showed a significant higher level of objectively measured PA at follow-up compared to CG. Dietary behavior and fruit and vegetable consumption significantly increased from baseline to follow-up in CG, but not IG. IG showed a significant increase in some, but not all social cognitive determinants of health behavior change.

CONCLUSIONS

MoVo-LISA is effective in helping outpatients with MD to increase their level of PA in short- and mid-term. The used intervention strategies are effective for the promotion of healthy diet in patients with MD as well.

Prevalence and determinants of physical activity in a mixed sample of psychiatric patients in Saudi Arabia

OBJECTIVES

To estimate prevalence of physical activity and its associations with various psychiatric disorders and the use of psychotropic medications.

METHODS

A cross-sectional observational study was carried out between July 2012 and June 2014. Patients were enrolled from a number of hospitals located in 5 regions of the Kingdom of Saudi Arabia.

RESULTS

A total of 1185 patients were included in current analysis: 796 were outpatients, and 389 were inpatients. Out of 1,185 patients, 153 (12.9%) were physically active. Much higher rates of physical activity were reported among males than females (15.9% versus 9.6%, p less than 0.001). According to the univariate analysis, higher rates of physical activity were positively correlated with primary bipolar disorders, the use of antianxiety medications and, to a lesser extent, use of antipsychotic medications, but they were negatively correlated with primary anxiety disorders, use of antidepressant medications, and use of multiple psychotropic medications. The associations between physical activity and primary bipolar disorders (odds ratio [OR]=2.47, p=0.002), use of antianxiety medications (OR=3.58, p=0.003), and use of multiple psychotropic medications (OR=0.33, p less than 0.001) remained significant after adjusting for demographic and clinical characteristics.

CONCLUSION

We report a variable but generally low prevalence of physical activity among a large, mixed sample of psychiatric patients in Saudi Arabia. These findings may highlight the importance of assessing physical activity status of psychiatric patients and the critical need for physical activity promotion programs among this group of disadvantaged patients.

The Health and Well-being of Children and Adolescents Accessing In-Patient Psychiatry: A Brief Report

OBJECTIVE

People with mental illness have high rates of physical illness that are not detected and that shorten their lifespan. Health behaviours are central to physical health, and many children and adolescents with psychiatric illness may be at risk for poor physical health. The purpose for this study was to explore the self-reported health behaviours and well-being of pediatric psychiatric patients and their association with mental health problems.

METHODS

Pediatric patients hospitalized for psychiatric care were invited to complete a survey containing items on amount of physical activity, nutrient intake and sleep, a standardized perceived stress scale, and the Strengths and Difficult Questionnaire.

RESULTS

Informed consent was provided by 161 patients who completed the survey. Youth reported: engaging in very little physical activity, eating fruits and vegetables about 2-3 times per week, not sleeping well and very high perceived stress.

DISCUSSION

Implications for practice include increasing opportunities for and monitoring of health behaviours in youth hospitalized for psychiatric illness. Further research is needed to explore interventions designed to improve the physical health and mental well-being of youth with psychiatric illness and possibly the inpatient environment.

Physical Activity Interventions for Children with Social, Emotional, and Behavioral Disabilities-A Systematic Review

OBJECTIVE

Perform a systematic review of the available literature regarding the effectiveness of exercise interventions on children with any type of social, emotional, or behavioral disability (SEBD), with attention to a range of physiological, behavioral, and mood outcomes.

METHODS

Six databases were searched using a systematic methodology. References of included studies, as well as relevant reviews, were also examined. The review was limited to studies published since 2000 reporting a quantitative analysis of the effects of a physical activity (PA) intervention on at least 1 behavioral, psychological, or cognitive outcome in children aged 21 and under, diagnosed with a SEBD. Only studies with a control group were included.

RESULTS

We identified 24 eligible studies. Studies varied in design, participant characteristics, and intervention characteristics (single-bout vs repeated exposure, duration, intensity level, mode of exercise). Of the 20 behavioral outcome assessments, there was 1 negative finding, 12 null findings, 5 positive findings, and 2 mixed findings. For the 25 executive functioning outcome assessments, there were 5 null findings, 18 positive findings, and 2 mixed findings. For the remaining outcome domains, 1 of 2 studies looking at academic performance, 3 of 6 studies looking at objective neurological measures, and 1 of 3 studies looking at affect outcomes found positive results. All other results were null or mixed.

CONCLUSION

Although additional research is warranted to further understand the mechanisms by which PA affects behavioral and cognitive outcome measures in children with SEBDs, PA offers a safe and alternative form of treatment for this population.

Incomplete total body protein recovery in adolescent patients with anorexia nervosa

Background

Bone health and growth during adolescence require adequate total body protein (TBPr). Renutrition for patients with anorexia nervosa (AN) should aim to normalize body composition and to recover both fat mass and TBPr.

Objective

We intended to analyze predictors of protein status, including exercise status, in adolescents with AN and to investigate whether weight gain would replenish body protein deficits.

Methods

We assessed TBPr in a longitudinal, observational study as height-adjusted nitrogen index (NI) using in vivo neutron activation analysis in 103 adolescents with AN [mean ± SD age, 15.6 ± 1.4 y; body mass index (BMI, in kg/m2), 16.5 ± 1.6] at the commencement of inpatient refeeding (T0), in 56 of these patients 7 mo thereafter as outpatients (T1), and in age-matched controls (C; n = 51, 15.5 ± 2.1 y, BMI 20.7 ± 1.9). Lean tissue and fat mass were assessed by dual-energy X-ray absorptiometry. BMI, BMI standard deviation score, and lean tissue mass were tested as predictors of protein status using receiver operating characteristic analysis.

Results

At T0, NI was decreased in AN (AN, 0.88 ± 0.10 compared with C, 1.00 ± 0.08, P < 0.001). In 34%, the patients showed protein depletion. Patients classified as ``exercisers'' had a higher NI than did ``nonexercisers'' (0.89 ± 0.11 compared with 0.85 ± 0.08, P = 0.045). BMI, BMI standard deviation score, and lean tissue mass did not show potential as predictors of protein status. Despite increases in weight (+6.9 ± 4.5 kg), and BMI (+2.5 ± 1.7), protein status did not improve (TBPr T0, 8.0 ± 1.1 kg; T1, 8.1 ± 1.0 kg, P = 0.495). In an AN subgroup at 7 mo matched with controls in age (AN, 16.5 ± 1.1 y; C, 16.2 ± 1.8 y) and BMI (AN, 20.5 ± 1.4; C, 20.7 ± 1.3), protein status was still not normalized in AN (NI: AN, 0.89 ± 0.09 compared with C, 1.00 ± 0.07, P < 0.001).

Conclusions

Adolescents recovering from AN remained protein depleted at 7 mo after baseline assessment, even though they were weight restored.

Translating benefits of exercise on depression for youth with autism spectrum disorder and neurodevelopmental disorders

Young adults with Autism Spectrum Disorder (ASD) are at increased risk of poor health and depressive symptoms due to difficulty with communication, limited interests, sensory deficits, and sedentary lifestyles. The Piece It Together program was developed to provide socialization and wellness goals for teens and young adults with ASD and other mild neurocognitive deficits. The curriculum includes strength and endurance training, nutrition education, and stress reduction techniques to promote healthy lifestyle choices. Twelve participants, aged 15-27, attended 90-minute classes at the MUSC Wellness Center twice a week for six weeks and were encouraged to increase their activity level every day. The Patient Health Questionnaire (PHQ-9) was administered to each participant at the first and last class. Results showed significantly decreased PHQ-9 depression scores at the end of the program, from mild (7.69) to minimal depression (3.42) (p=0.000063). Overall, the activities completed in the Piece It Together program successfully unified this group to promote healthy lifestyle choices and resulted in improved mood.

Injury risks in schoolchildren with attention-deficit/hyperactivity or autism spectrum disorder: Results from two school-based health surveys of 6- to 17-year-old children in Sweden

INTRODUCTION

Injuries are one of the leading causes of death and disability among children in Sweden and attention-deficit/hyperactivity disorder (ADHD) has previously been associated with an increased risk of injury in pediatric populations elsewhere in the world. Current evidence regarding the possible link between autism spectrum disorder (ASD) and injury risk appears limited, even though some potentially risk-increasing symptoms overlap. The purpose of this study was thus to study the association between both ADHD and ASD concerning the risk of injury among Swedish schoolchildren.

METHODS

Two samples were used: a population-based register study containing data from 18,416 children ranging from the ages of 6-17years collected by school nurses during 2012/2014 (Survey A), and a national cross-sectional study of 3202 ninth-grade children (~15years old) collected from 92 schools in 2011 (Survey B). The data were analyzed using χ(2)-tests and log-binomial generalized linear models to obtain risk ratios (RR), comparing cases reportedly affected by ADHD or ASD to unaffected controls.

RESULTS

After adjusting for confounders, ADHD was associated with a 65% increased risk of injury (RR 1.65 [95% CI: 1.32-2.05] in Survey A, and a 57% increased risk of injury (RR 1.57 [95% CI: 1.27-1.95]) in Survey B. ASD was not significantly associated with any differences in injury risk (RR 0.81 [95% CI: 0.57-1.14]).

CONCLUSIONS

The results indicate that there is an elevated injury risk among Swedish schoolchildren with ADHD but not for children with ASD. Future studies should focus on causal mechanisms mediating the association between ADHD and injuries in order to facilitate injury prevention strategies.

PRACTICAL APPLICATIONS

Parents and teachers of schoolchildren with ADHD should be made aware of the elevated injury risks associated with the diagnosis. Safety experts and injury control professionals should consider the development of specialized prevention strategies in order to reduce these risks.

Chaining Functional Basketball Sequences (with Embedded Conditional Discriminations) in an Adolescent with Autism

Individuals with developmental disabilities successfully participate in fewer recreation activities, including sports activities, than their typically developing peers. Although a functional basketball-playing repertoire might increase social opportunities and physical health for these individuals, no research has outlined a behavior-analytic strategy for teaching this sport. In our study, we taught a 13-year-old male diagnosed with autism to play basketball. During phase 1, we employed discrete-trial training to establish proficiency with nine fundamental basketball skills (i.e., recruiting attention, passing, dribbling, etc.). During phase 2, we used a forward chaining procedure to teach-specific sequences of these component skills that are appropriate for playing offense and defense and for participating in a full-court basketball drill. The participant learned all pre-requisite skills and response chains came under the control of contextually appropriate discriminative stimuli.

The current state of physical activity and exercise programs in German-speaking, Swiss psychiatric hospitals: results from a brief online survey

BACKGROUND

Physical activity and exercise programs (PAEPs) are an important factor in increasing and maintaining physical and mental health. This holds particularly true for patients with psychiatric disorders undergoing treatment in a psychiatric hospital. To understand whether the benefits reported in the literature are mirrored in current treatment modalities, the aim of the present study was to assess the current state of PAEPs in psychiatric hospitals in the German-speaking part of Switzerland.

METHODS

All psychiatric hospitals (N=55) in the German-speaking part of Switzerland were contacted in spring 2014. Staff responsible for PAEPs were asked to complete an online questionnaire covering questions related to PAEPs such as type, frequency, staff training, treatment rationale, importance of PAEPs within the treatment strategy, and possible avenues to increase PAEPs.

RESULTS

Staff members of 48 different psychiatric hospitals completed the survey. Hospitals provided the following therapeutic treatments: relaxation techniques (100%), sports therapy (97%), activity-related psychotherapeutic interventions (95%), physiotherapy (85%), body therapies (59%), far-east techniques (57%), and hippotherapy (22%). Frequencies ranged from once/week to five times/week. Approximately 25% of patients participated in the PAEPs. Interventions were offered irrespective of psychiatric disorders. PAEP providers wanted and needed more vocational training.

CONCLUSION

All participating psychiatric hospitals offer a broad variety of PAEPs in their treatment curricula. However, the majority of inpatients do not participate in PAEPs. Furthermore, those who do participate cannot continue to do so following discharge. PAEP providers need specific extended vocational trainings and believe that the potential of PA should be improved.

Problematic Exercise in Anorexia Nervosa: Testing Potential Risk Factors against Different Definitions

“Hyperactivity” has a wide prevalence range of 31% to 80% in the anorexia nervosa literature that could be partly due to the plethora of definitions provided by researchers in this field. The purpose of this study was two-fold: 1) To assess the variance across prevalence rates of problematic exercise encountered in patients with anorexia nervosa, in relation to seven different definitions found in the literature. 2) To examine how core eating disorder symptoms and the dimensions of emotional profile are associated with these different definitions and the impact of these definitions on the assessment of patients’ quality of life. Exercise was evaluated in terms of duration, intensity, type and compulsion using a semi-structured questionnaire administered to 180 women suffering from severe anorexia nervosa. Seven different definitions of problematic exercise were identified in the literature: three entailing a single dimension of problematic exercise (duration, compulsion or intensity) and four combining these different dimensions. Emotional profile scores, obsessive-compulsive symptoms, eating disorder symptomatology, worries and concerns about body shape, self-esteem and quality of life were assessed using several established questionnaires. The prevalence of problematic exercise varied considerably from, 5% to 54%, depending on the number of criteria used for its definition. The type and level of eating disorder symptomatology was found to be associated with several definitions of problematic exercise. Surprisingly, a better self-reported quality of life was found among problematic exercisers compared to non-problematic exercisers in three of the definitions. The different definitions of problematic exercise explain the broad prevalence ranges and the conflicting associations generally reported in the literature between problematic exercise and eating disorder-related psychological parameters. There is an urgent need for a valid consensus on the definition of problematic exercise in anorexia nervosa. This will support the development of further research on the etiology and treatment of problematic exercise.

A pilot study of actigraphy as an objective measure of SSRI activation symptoms: results from a randomized placebo controlled psychopharmacological treatment study

Selective serotonin reuptake inhibitors (SSRIs) are an efficacious and effective treatment for pediatric obsessive-compulsive disorder (OCD) but have received scrutiny due to a potential side effect constellation called activation syndrome. While recent research introduced a subjective measure of activation syndrome, objective measures have not been tested. This pilot study, using data from a larger randomized-controlled trial, investigated the potential of actigraphy to provide an objective measure of activation symptoms in 44 youths with OCD beginning an SSRI medication regimen. Data were collected over the first four weeks of a multi-site, parallel, double-blind, randomized, placebo controlled psychopharmacological treatment study and statistical modeling was utilized to test how activation syndrome severity predicts daily and nightly activity levels. Results indicated that youths with higher activation symptoms had lower daytime activity levels when treatment averages were analyzed; in contrast youths who experienced onset of activation symptoms one week were more likely to have higher day-time and night-time activity ratings that week. Results support actigraphy as a potential objective measure of activation symptoms. Subsequent studies are needed to confirm these findings and test clinical applications for use by clinicians to monitor activation syndrome during SSRI treatment. National Institutes of Health (5UO1 MH078594-01); NCT00382291.

A therapeutic skating intervention for children with autism spectrum disorder

PURPOSE

The purpose of this study was to evaluate the effects of a highly structured therapeutic skating intervention on motor outcomes and functional capacity in 2 boys with autism spectrum disorder aged 7 and 10 years.

METHODS

This multiple-baseline, single-subject study assigned participants to three 1-hour skating sessions per week for 12 weeks focusing on skill and motor development. Multiple data points assessed (a) fidelity to the intervention and (b) outcomes measures including the Pediatric Balance Scale, Timed Up and Go, floor to stand, Six-Minute Walk Test, goal attainment, and weekly on-ice testing.

RESULTS

Improvements were found in balance, motor behavior, and functional capacity by posttest with gains remaining above pretest levels at follow-up.

CONCLUSIONS

Therapeutic skating may produce physical benefits for children with autism spectrum disorder and offer a viable, inexpensive community-based alternative to other forms of physical activity.